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Good morning

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Indicators OF HEALTHSUBMITTED BY SONIA ALEX

GUIDED BY DR MAHAMOOD MOOTHEDATH DR AZEELA AHMMED

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Table of contents

IntroductionDefinitionRequirement of an indicatorCharacteristics of an indicatorMeasurement of healthClassification of indicatorsConclusionReference

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INTRODUCTION• Health is defined as a state of complete physical mental and social wellbeing and not merely an absence of disease or infirmity(WHO).

• This statement have been amplified to include the ability to lead a socially and economically productive life.

• Health cannot be measured in exact measurable forms hence measurement have been framed in terms of illness consequence of ill health(mortality, morbidity) and economic, occupation and domestic factors that promote ill health.

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Indicators of health

Defined as variables which help to measure changesOften they are used particularly when these changes cannot be measured directly . Eg ; health or nutritional status Its also termed as index or variables Its only a indication of a given situation or reflection of that

situation Health indicator is variable, susceptible to direct

measurements that reflects the state of health of persons in society

If measured sequentially over time , they can indicate direction and speed of change and serve to compare different areas or group of people at the same moment in time

Indicators help to measure the extent to which the targets of objectives and programmes are being attained

Health index is a numerical indication of the health of a given population derived from a specified composite formula

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uses of an indicator• To measure health status of a community• To compare health status of a country with that of another or

between communities• For identification of health care needs and prioritizing them• For planning and allocation of health care needs• For monitoring and evaluation of health services activities

and programmes• Helps to measure the extent to which the objectives and

targets of a programmes are being attained and identify areas of improvement

• Measurement of health success

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Characteristics of indicators

Indicators have given scientifis

respectability.eg;ideal indicators should be

• VALID• RELIABLE• SENSITIVE• SPECIFIC• FEASIBLE • RELEVANT

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CLASSIFICATION OF INDICATORS1. MORTALITY INDICATORS

2. MORBIDITY INDICATORS

3. DISABILITY RATES

4. NUTRITIONAL STATUS INDICATORS

5. HEALTH CARE DELIVERY INDICATORS

6. UTILISATION 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

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1 . Mortality indicatorsCRUDE DEATH RATES• This is considered as 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 of crude death rate is restricted because

it is influenced the age –sex composition of the population , socio-economic and socio cultural environment of the communities,

• Current CDR :7.48 deaths /1000 population

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EXPECTATION OF LIFE

• life expectancy at birth is the average number of years that will be lived by those born alive into a population if the current age specific mortality rates persists

• Life expectancy at birth is used most frequently• It is estimated for both sexes separately• An increase in the expectation of life is regarded as

an improvement on health status• Good indicator of socio economic development• Positive health indicator of long time survival of life• It has been adopted as a global health indicator• Total population : 66.8 years , male :65.77 years female :67.95years

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INFANT MORTALITY RATE

• The ratio of deaths of under 1 year 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 and socio economic conditions

• Sensitive indicator of the availability , utilization and effectiveness of health care, particularly perinatal care

• Current IMR : 47.57/1000 live birthsUNDER 5 PROPORTIONATE MORTALITY RATE : defined as proportion of total deaths occuring in the under 5 age group• Reflects both infant and child mortality rate• Current rate : 66.59/1000• High rate reflects high birth rates , high child

mortality rates and shorter life expectancy

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CHILD MORTALITY RATE

• the number of deaths at the ages 1-4 years in a given year , per 1000 children in that age group at the mid point of year consumed

• It excludes IMR• correlates with inadequate MCH services ,

malnutrition ,low immunization coverage and adverse environment exposure and other exogenous agents

• Current rate : 18/ 1000

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• Accounts for the greatest proportion of deaths among women of reproductive age in developing countries

• Ratio of number of deaths arising during pregnancy or puerperal period per 1000 live births

MATERNAL MORTALITY RATE

Current MMR- 254/10000 live births

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PROPORTIONAL MORTALITY RATEIt is the proportion of all deaths attributed to specific diseases Eg : coronary heart disease is the cause of 25-30% of all deaths in most western countriesUseful health status indicator in case of communicable diseases as it indicates the magnitude of preventable mortality

mortality rate which is computed for specific diseasesEg: TB mortality rate is 23 per 100000 population per yearOther indicators : deaths from cancer ,cardio vascular diseases, accidents, diabetes etc

DISEASE SPECIFIC MORTALITY RATE•

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2 . Morbidity indicators

• Morbidity indicators reveal the burden of ill health in a community unlike mortality indicator

• Eg :mental illness and rheumatoid arthritis• Therefore used to supplement mortality data to

describe the health status of a population• DRAWBACK : Do not measure subclinical or in

apparent disease states. i.e hidden part of the iceberg of disease

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Morbidity rates used for assessing ill health in the community• INCIDENCE AND PREVALENCE

Incidence : the number of new cases or new events of a disease in a defined population, with in a specified period of time

Eg : Incidence of TB (new sputum positive cases) is 168/100000 population per year Prevalence : The total number of all individuals who have an attribute or disease at a particular time divided by population at risk of having attribute or disease at this point of time Reflects the chronicity of the disease Eg :Prevalence of TB (sputum positive in population) is 249/100000 population

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• NOTIFICATION RATES

Calculated from the reporting to public authorities of certain disease

Eg: yellow fever , poliomyelitis

They provide information regarding geographic clustering of infections, quality of reporting systems e.t.c• ATTENDANCE RATES AT OPD, HEALTH CENTRES

ETC• ADMISSION , READMISSIN AND DISCHARGE RATES• DURATION OF STAY AT HOSPITAL – reflects the

virulence and resistance developed by the etiological factor• SPELLS OF SICKNESS OR ABSENCE FROM WORK

OR SCHOOL – reflects economical loss to the community• Hospital data constitute a basic and primary source of

information about the disease prevalent in the community

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3 . Disability rates•Falls into two groups EVENT TYPE INDICATOR

- No of days of restricted activity - Bed disability days

- Work loss days with in a specified period PERSON TYPE INDICATORS

-Limitation of mobility

• For eg :confined to bed ,confined to the house , special aid in getting around either inside or outside the house

-limitation of activity

• Limitation to perform the basic activities of daily leaving(ADL)

Eg: eating washing dressing • Limitation in major activity

Eg: Ability to work at a job, ability to house work

Sullivan’s index

• Refers to “Expectation of life free of Disability”

• =life expectancy of the country - probable duration of bed disability and inability to form major activities

• Eg : the expectation of life at birth for all persons in the U.S.A in 1965 was 70.2years and the approximate expectation of life free of disability worked out to be 64.9years

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HEALTH ADJUSTED LIFE

EXPECTANCY(HALE]

• DALE HALE• Measure healthy life

expectancy• HALE is based on life

expectancy at birth but includes an adjustment for time spent in poor health

• It is equivalent to the number of years in full health that a newborn can expect to live based on current rates of ill health and mortality

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DALY(DISABILITY-ADJUSTED LIFE YEAR)

• It is the most simplest and commonly used measure to find the burden of disease in a defined population and the effectiveness of interventions

• Express years of life lost due to premature death and years lived with disability adjusted for the severity of disability

• One DALY is “one lost year of healthy life• Two things used 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 temporary (TB)or permanent(polio), physical or mental

USES OF DALY• To assist in selecting health service priorities• To identify the disadvantaged groups• Targeting health interventions• Providing comparable measures for planning and evaluating

programmes• To compare the health status of different countries

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PREMATURE DEATH Defined as one that occurs before before the age to which a dying person could have expected to survive if she or he was a member of standardized mode of population with a life expectancy at birth equals to that of the world’s longest surviving population eg : Japan

QALY(QUALITY ADJUSTED LIFE YEAR)• It is the most commonly used ,to measure the

cost effectiveness of health interventions• It estimates the number of years of life added

by a successful treatment or adjustment for quality of life

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4 . Nutritional status indicators

• It is a positive health indicator • They are

- newborns are measured for their birth weight , length and head circumference → they reflects the maternal nutritional status

-anthropometric measurements of preschool children

weight → measures acute malnutrition

height → measures chronic malnutrition

mid arm circumference → measures chronic malnutrition

- growth monitoring of children done by measuring heights of children at school entry, height and weight records of school going children

-prevalence of low birth weight (less than 2.5 kg)• In adults underweight , obesity and anemia are generally

considered reliable nutritional status indicators

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5 . Health care delivery indicators

• These indicators reflect the equity of distribution of health resources in different parts of the country and of the provision of health care

• Frequently used indicators are

a)Doctor- population ratio 1/1700

b)Doctor nurse ratio 0.8/1000

c)Population bed ratio 8.9/10000

d)Population per health/ sub center 30000

e)Population per traditional birth attendant 0.4/1000

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No of health workers available in 1000 population in india

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6 . Service utilization rates• It deals with the extent of use of health services• Utilization of services or actual coverage 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 and accessibility of health services and attitude ofan individual towards his health and health care systems

• They direct attention towards the discharge of social responsibility for the organization in delivery of health care services

• Eg:

a) Proportion of infants who are “fully immunized

b) Proportion of women aho receive antenatal care or have their deliveries supervised by a trained birth attendant

c) Percentage of population using the various

methods of family planning

d) Bed- occcupancy rate

e) Average length of stay

f) Bed- turn over ratio

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7.Indicators of social and mental health• These include suicide , homicide, other acts of

violence and other crime , road traffic accidents, juvenile delinquency , alcohol and drug abuse, smoking , consumption of tranquillizers, obesity , family violence ,battered baby and battered wife syndrome ,and neglected and abandoned youth in the neighbourhood

• Social and mental health of the children depends on their parents .

•eg: substance abuse in orphan children• These indicators provides a guide to social action for

improving the health of the people

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Patients receiving mental councelling today

Surveys show that indian women are more stressed than others

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8. Environmental indicators

• These reflect the quality of physical and biological environment in which diseases occur and in which the people live

• The most important are those measuring the proportion of population having access to safe water and sanitation facilities

•Eg: percentage of households with safe water in the home or with in 15 minutes walking distance from a water stand point or protected well; adequate sanitary facilities in the home or immediate vicinity• The other indicators are those measuring the pollution of air

and water, radiation, solid wastes , noise , exposure to toxic substances in food or drinks

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9 .socioeconomic indicators• These do not directly measure health but are important in interpreting

indicators of health• These includes various factors affecting and depicting socioeconomic

status

1. Rate of population increase

2. Per capita GNP

3. Level of unemployment

4. Dependency ratio

5. Literacy rates , especially female literacy rates•Under age group 15- 19, only 89% of men and 74% of women are literate•6.Family size•7. housing: the number of persons per room•8.Per capita “calorie” availability• Countries with favorable socioeconomic indicators have reported less

health related problems

Indias most literacy state with best socio economic indicator

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10 . Health policy indicators• The single most important indicator of POLITICAL

COMMITMENT is allocation of adequate resources • The relevant indicators are

1. Proportion of GNP spent on health services

2. Proportion of GNP spent on health related activities

3. Proportion of total health resources devoted to primary health care

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11 . Indicators of quality of life• It is a composite measure of physical, mental and

social wellbeing as perceived by each individual or group of individuals

• That’ is to say happiness , satisfaction and gratification as it is experienced in such life concerns as health , marriage , family work , financial situation , educational opportunities , self esteem , creativity , belongingness and trust in others

• Life expectancy is no more important but the quality of life enjoyed by individuals and communities has gained its importance

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HUMAN DEVELOPMENT INDEX

• It is defined as a composite index combining indicators representing three dimensions .LONGEVITY(life expectancy at birth) KNOWLEDGE(2/3 adult literacy rate and 1/3 mean years of schooling)INCOME(real GDP per capita in purchasing power parity in U.S dollars)

• Index= actual value – minimum value• The resulting is placed on 0 to 1 scale• For India , HDI = 0.519

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Human development index tree

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Physical quality of life index

• It is a composite index obtained from number of health indicators

• It consolidates three indicators viz infant mortality , life expectancy at age of 1year and literacy . These components measures rather than inputs , therefore tends themselves for national and international comparisons

• For each component , the performance of individual countries is placed on a scale of 0 to 100, where 0 represents absolutely defined worst performance and 100 represents absolutely defined best performance

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• The composite index is calculated by averaging the 3 indicators, giving equal weight to each of them. The resulting is placed on the 0 to 100 scale

• PQLI does not consider the GNP.it is intended to complement not to replace GNP

• Eg: the oil rich countries of middle east with high per capita incomes have infact not very PQLI’s where as Srilanka and Kerala state in India have low per capita incomes with high PQLI’s

• i.e it measures the social economic and political policies not the economic growth

• The ultimate objective is to attain a PQLI’s of 100

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12 . OTHER INDICATORS SERIES

SOCIAL INDICATORSsocial indicators , as defined by the United Nations

Statistical office, have been divided into 12 categories

1. Population

2. Family formation

3. Families and house holds

4. Learning and educational services

5. Earning activities

6. Distribution of income ,Consumption and accumulation

7. 7. Social security and welfare services

8. 8. Health services and nutrition

9. 9. Housing and its environment

10. Public order and safety

11. Time use , Leisure and culture

12. 12 .Social stratification and mobility

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Basic needs indicators

• Used by ILO • Basic needs performance Includes

1. calorie consumption

2. Access to water

3. Life expectancy

4. Deaths due to disease

5. Illiteracy

6. Doctors and nurses per population

7. Rooms per person

8. GNP per capita

Life expectancy and age groups

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• For monitoring progress towards the goal HEALTH FOR ALL by 2000A.D,the WHO has listed the following four categories of indicators

HEALTH POLICY INDICATORS• Political commitment to health for all• Resource allocation• The degree of equity of distribution of health services• Community involvement• Organizational frame work and managerial process SOCIAL AND ECONOMIC INDICATORS RELATED TO

HEALTH• Rate of population increase• GNP or GDP• Income distribution• Work conditions• Adult literacy ratio• Housing • Food availability

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Indicators for the provision of health care

Health status indicators

low birth weight Nutritional status and psychosocial development of children

Infant mortality rateChild mortality rate

Life expectancy at birthMaternal mortality rate

Disease specific mortality Morbidity- incidence and prevalence

Disability prevalence

AvailabilityAccessibility

UtilizationQuality of care

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Millennium development goal indicators• Adopted by United Nations in the year 2000• Provides an opportunity for concerted action to improve global

health• HEALTH RELATED GOALS AND THEIR INDICATORS IN PROGRESS

GOAL1: Eradicate extreme poverty and hunger• Indicator4 :Prevalence of underweight children under 5 years of age• Indicator 5:proportion of population below minimum level of dietary energy consumption

GOAL4:Reduce child mortality • Indicator 13:under 5 mortality rate• Indicator 14:Infant mortality rate• Indicator 15:Proportion of 1year old children immunized against measles

GOAL5:Improve maternal health• Indicator 16:Maternal mortality ratio• Indicator 17:Proportion of births attended by skilled health personnel

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Millennium development goal indicators

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GOAL 6: Combat HIV/AIDS , malaria and other diseases• Indicator18 :HIV prevalence among young people aged

15 – 24 years• Indicator19: condom use rate of the contraceptive

prevalence rate • Indicator 20: Number of children orphaned by

HIV/AIDS• Indicator 21:Prevalence and death rates associated with

malaria• Indicator 22:proportion of population in malaria risk

areas using effective malarial prevention and treatment measures

• Indicator 23: Prevalence and death rates associated with TB

• Indicator24:Proportion of TB cases detected and cured under Directly Observed Treatment,short course(DOTS)

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GOAL 7:Ensure environmental sustainability• Indicator 29:Proportion of population using solid fuel• Indicator 30: Proportion of population with sustainable

access to an improved water source, urban and rural• Indicator 31:Proportion of urban population with access

to improved sanitation

GOAL 8:Develop a global partnership for development • Indicator 46 :Proportion of population with access to

affordable essential drugs on a sustainable basis

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Conclusion• Health is not measured directly but using indicators• Indicator should be valid , sensitive , reliable, specific,

relevant and feasible• Used in measuring , describing , comparing ,

identifying health needs and planning and evaluation of health services

• Each available indicator reflects an aspect of health .i• The ideal index is yet to be developed , search for a

global index of health status continues……………from an economic preference to society’s performance and quality of life

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Reference

• Park’s text book of preventive and social medicine- K. PARK-18th edition

• Textbook of community dentistry- SATISH CHANDRA• Essentials of preventive and community dentistry – SOBEN

PETER -4th edition• Textbook of preventive and community dentistry – JOSEPH

JOHN -2nd edition

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THANK YOU

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