Concept and Indicators of Health PDF

By Ashraf Hussain MBChB.PhD/COM.MED The image part with relationship ID rId1 was not found in the file. Objectives 1. Definition of health...

By Ashraf Hussain MBChB.PhD/COM.MED The image part with relationship ID rId1 was not found in the file. Objectives 1. Definition of health 2. Determinants of health 3. Measures of health The image part with relationship ID rId1 was not found in the file. Health WHO definition The widely accepted definition of health is that given by the World Health Organization ( 1948), which is as follows "Health is a state of complete physical, mental and social well-being and not merely an absence of disease or infirmity“  In recent years, this statement has been amplified to include the ability to lead a "socially and economically productive life The image part with relationship ID rId1 was not found in the file. The determinants of health include: Individuals are unlikely to be able to directly control many of the determinants of health. These determinants—or things that make people healthy or not—include  Income and social status - higher income and social status are linked to better health. The greater the gap between the richest and poorest people, the greater the differences in health.  Education – low education levels are linked with poor health, more stress and lower self-confidence. The image part with relationship ID rId1 was not found in the file.  Physical environment – safe water and clean air, healthy workplaces, safe houses, communities and roads all contribute to good health.  Employment and working conditions – people in employment are healthier, particularly those who have more control over their working conditions  Social support networks – greater support from families, friends and communities is linked to better health. Culture - customs and traditions, and the beliefs of the family and community all affect health. The image part with relationship ID rId1 was not found in the file.  Genetics - inheritance plays a part in determining lifespan, healthiness and the likelihood of developing certain illnesses. Personal behavior and coping skills  balanced eating, keeping active, smoking, drinking, and how we deal with life’s stresses and challenges all affect health.  Health services - access and use of services that prevent and treat disease influences health  Gender - Men and women suffer from different types of diseases at different ages. The image part with relationship ID rId1 was not found in the file. Social Determinants of Health Economic Stability:  Financial security plays a crucial role in determining one’s health.  Individuals facing poverty or unstable employment often struggle to afford nutritious food, secure housing, and access healthcare services.  By not having access to resources that require money, the cycle of poverty continues and makes an inescapable loop for many individuals and families.  Economic stability also impacts stress levels, mental health, and overall quality of life. The image part with relationship ID rId1 was not found in the file. Education Access and Quality:  Education serves as a cornerstone for health.  Access to quality education equips individuals with essential knowledge and skills to make informed health decisions.  It also influences employment opportunities, income levels, and social mobility, thereby impacting health outcomes across generations. The image part with relationship ID rId1 was not found in the file. Health Care Access and Quality:  Accessible and high-quality healthcare services are fundamental for maintaining good health.  Barriers such as lack of insurance, geographic distance, and cultural differences can hinder individuals from receiving timely care, leading to disparities in health outcomes. The image part with relationship ID rId1 was not found in the file. Neighbourhood and Built Environment:  The physical environment in which people live, work, and play significantly influences health.  Factors like housing conditions, air quality, access to green spaces, and community safety impact individuals’ ability to engage in healthy behaviors and access resources for well-being. The image part with relationship ID rId1 was not found in the file.  Social and Community Context:  Social relationships, support networks, and community resources play a vital role in shaping health.  Strong social connections foster resilience, reduce stress, and provide avenues for social participation and support.  Social isolation, discrimination, and lack of community cohesion can also heavily contribute to adverse health outcomes due to a lack of support and resources from others. The image part with relationship ID rId1 was not found in the file.  Recognizing and addressing the social determinants of health is essential for achieving optimal health outcomes and reducing health disparities.  By prioritizing economic stability, education, healthcare access, neighborhood environments, and social contexts, societies can create conditions conducive to health and well-being for all individuals. The image part with relationship ID rId1 was not found in the file. INDICATORS OF HEALTH Indicators are required to measure 1. The health status of a community 2. To compare the health status of one country with that of another 3. For assessment of health care needs 4. For allocation of scarce resources 5. For monitoring and evaluation of health services, activities, and programmes. 6. To measure the extent to which the objectives and targets of a programme are being attained. The image part with relationship ID rId1 was not found in the file. Characteristics of useful health indicators 1. Measurability and feasibility: if can not measured or complex so monitoring of progress is not easy. 2. Validity: the ability of the indicator to measure what it is intended to measure 3. Timeliness 4. Replicability 5. Sustainability 6. Relevance and Importance 7. Comprehensible The image part with relationship ID rId1 was not found in the file. Classification of health indicators The image part with relationship ID rId1 was not found in the file. Indicators based on the mathematical measurements  Counts: Absolute frequency Basic information Of limited value especially for spatial or temporal comparisons with high difference in the reference populations Except for example setting the required amount of drugs of those patients with specific disease So>>> ratios are better The image part with relationship ID rId1 was not found in the file. RATIO  Measure of disease frequency  It expresses a relation in size between two random quantities were the numerator is not a component of the denominator  Broadly, ratio is the result of dividing one quantity by another.  Note that in certain ratios, the numerator and denominator are different categories of the same variable, such as males and females, or persons 20–29 years and 30–39 years of age.  In other ratios, the numerator and denominator are completely different variables, such as the number of hospitals in a city and the size of the population living in that city, Maternal Moratality ratio The image part with relationship ID rId1 was not found in the file. odds  The numerator is the proportion of event of interest and the denominator is the proportion of the non- event (P/1-p).  Private to public hospaital beds  200/300 The image part with relationship ID rId1 was not found in the file. PROPORTION  is a ratio which indicates the relation in magnitude of a part to the whole.  The numerator is always included in the denominator.  A proportion is usually expressed as a percentage.  Private to public beds The image part with relationship ID rId1 was not found in the file. indicator numerator dinominator Value of the indicator Ratio of hospital beds to 300 beds 20,000 1.5 beds per 100 inhabitants inhabitants population Proportion (%) of public 250 beds 300 bed 83.3% public beds hospital beds Odds of public versus 250/300 50/300 5 public hospital beds private beds per 1 private beds The image part with relationship ID rId1 was not found in the file. Rate  A rate measures the occurrence of some particular event (development of disease or the occurrence of death) in a population during a given time period.  It is a statement of the risk of developing a condition.  It indicates the change in some event that takes place in a population over a period of time. The image part with relationship ID rId1 was not found in the file. Various categories of rates:  Crude rates: These are the actual observed rates such as the birth and death rates. Crude rates are also known as unstandardized rates.  Specific rates: These are the actual observed rates due to specific causes (e.g., tuberculosis); or occurring in specific groups (e.g., age-sex groups) or during specific time periods (e.g., annual, monthly or weekly rates).  Standardized rates: These are obtained by direct or indirect method of standardization or adjustment, e.g., age and sex standardized rates The image part with relationship ID rId1 was not found in the file. The image part with relationship ID rId1 was not found in the file. NUMERATOR AND DENOMINATOR  1. Numerator  Numerator refers to the number of times an event (e.g., sickness, birth, death, episodes of sickness) has occurred in a population, during a specified time- period.  The numerator is a component of the denominator in calculating a rate, but not in a ratio. The image part with relationship ID rId1 was not found in the file. 2. Denominator 1. MID-YEAR POPULATION: refers to the population estimated as on the first of July of an year. 2. POPULATION AT-RISK: The term is applied to all those to who have the opportunity to develop the event due to shared certain characteristic. In calculating "general fertility rate", the denominator is restricted to women of child-bearing age (i.e., 15-49 years); older women and little girls are excluded because they are not "at risk" of becoming pregnant. 3. PERSON-TIME: In some epidemiological studies (e.g., cohort studies),as person-month and person-years. The image part with relationship ID rId1 was not found in the file. Health indicators according to their mathmatical and epidemiological interpretations  Incidence:  An incident event is defined as a new event or a case of a disease (or death or any other health condition) that occurred in a specified time period.  Incidence  Concept: The image part with relationship ID rId1 was not found in the file. The image part with relationship ID rId1 was not found in the file. Characteristics Incidence rate refers only to 1. new cases 2. during a given period (usually one year) 3. in a specified population or "population at risk", unless other denominators are chosen. 4. it can also refer to new spells or episodes of disease arising in a given period of time, per 1000 population. For example, a person may suffer from common cold more than once a year. The image part with relationship ID rId1 was not found in the file.  Epidemiological concept: incidence rate calculates the probability of risk. The risk that an individual in a certain population got the event (whether disease, death, or other health condition) during a specific time period (eg. a year). The image part with relationship ID rId1 was not found in the file.  Incidence rate must include the unit of time used.  It is not influenced by the duration of the disease.  The use of incidence is generally restricted to acute conditions.  incidence rate can be denoted as attack rate when the population is exposed to risk for a limited period of time such as during an epidemic. The image part with relationship ID rId1 was not found in the file. The incidence rate, as a health indicator, represent the risk of occurrence of the disease and is useful for 1. Taking action to control disease, and for 2. Research into aetiology and pathogenesis, distribution of diseases, and efficacy of preventive and therapeutic measures The image part with relationship ID rId1 was not found in the file. PREVALENCE 1. The term "disease prevalence" refers specifically to all current cases (old and new) existing at a given point in time, or over a period of time in a given population. 2. "the total number of all individuals who have an attribute or disease at a particular time (or during a particular period) divided by the population at risk of having the attribute or disease at this point in time or midway through the period “ 3. Prevalence is of two types : (a) Point prevalence (b) Period prevalence The image part with relationship ID rId1 was not found in the file.  Epidemiological concept:  Prevalence rate determine who (at a specific time period) has the disease and who does not  It does not indicate the risk The image part with relationship ID rId1 was not found in the file. Relationship between prevalence and incidence Prevalence depends upon 2 factors,  the incidence and duration of illness.  Given the assumption that the population is stable, and incidence and duration are unchanging, the relationship between incidence and prevalence can be expressed as : P= IxD = incidence x mean duration The image part with relationship ID rId1 was not found in the file. Example (for a stable condition)  Incidence = 10 cases per 1000 population per year  Mean duration of disease = 5 years  Prevalence = 10 x 5= 50 per 1000 population So that the longer the duration of the disease, the greater its prevalence.  For example, tuberculosis has a high prevalence rate relative to incidence. This is because new cases of tuberculosis keep cropping up throughout the year, while the old ones may persist for months or years. The image part with relationship ID rId1 was not found in the file.  On the other hand, if the disease is acute and of short duration either because of rapid recovery or death, the prevalence rate will be relatively low compared with the incidence rate. In some diseases (e.g., food poisoning), the disease is so short-lived, there are no "old" cases.  The same is true of conditions which are rapidly fatal, such as some types of cancers.  In other words, decrease in prevalence may take place not only from a decrease in incidence, but also from a decrease of the duration of illness through either more rapid recovery or more rapid death. The image part with relationship ID rId1 was not found in the file.  When we see a change in prevalence from one time period to another, this can result from changes in incidence, changes in duration of disease or both. For example,  improvements in treatment may decrease the duration of illness and thereby decrease prevalence of a disease. But if  the treatment is such that by preventing death, and at the same time not producing recovery, may give rise to the apparently paradoxical effect of an increase in prevalence. The image part with relationship ID rId1 was not found in the file. The image part with relationship ID rId1 was not found in the file. Uses of prevalence  Prevalence helps to estimate the magnitude of health/ disease problems (Burden) in the community, and identify potential high-risk populations  Prevalence rates are especially useful for administrative and planning purposes, e.g., hospital beds, manpower needs, rehabilitation facilities, etc. The image part with relationship ID rId1 was not found in the file. References  health indicators conceptual and operational considerations. Available at  https://www.paho.org/en/documents/health- indicators-conceptual-and-operational-considerations