Download as PDF, PPTX
Uploaded byDr Lipilekha Patnaik
Indicators of health
The document provides a comprehensive overview of health indicators, defining health as a state of complete physical, mental, and social well-being. It categorizes these indicators into health status, health determinants, and various specific indicators such as mortality and morbidity rates, and highlights their importance in measuring health outcomes and evaluating health services. Additionally, it discusses the relevance of socio-economic, environmental, and policy-related indicators that contribute to understanding overall community health.
More Related Content
Similar to Indicators of health
Indicators of health
- 1. INDICATORS OF HEALTH DrLipilekha Patnaik Professor, Community Medicine Institute of Medical Sciences & SUM Hospital Siksha ‘O’Anusandhan deemed to be University Bhubaneswar, Odisha, India Email: [email protected]
- 2. CONTENTS • Introduction • Health •Indicators of Health • Characteristics • Uses • Classification of Indicators of Health • Summary • References
- 3. INTRODUCTION • Health isdefined as “a state of complete physical, mental & social wellbeing, and not merely an absence of disease or infirmity” (WHO) • 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 • Hence measurement have been framed in terms of illness (or lack of health), consequences of ill-health (morbidity, mortality) & economic, occupation & domestic factors that promote ill health.
- 4. Indicators WHO defines Indicatorsas: “variables which measure change”
- 5. INDICATORS OF HEALTH • Indicatoris a variable which gives an indication of a given situation or a reflection of that situation. • Health Indicator is a variable, susceptible to direct measurement, that reflectsthe state of health of persons in a community. • Indicators help to measure the extent to which the objectives and targetsof a programme are being attained.
- 6. INDICATORS OF HEALTH •Health status indicators measure different aspects of the health of a population. Examples include life expectancy, infant mortality, disability or chronic disease rates. • Health determinant indicators measure things that influence health. Examples include diet, smoking, water quality, income and access to health services
- 7. CHARACTERISTICS • Valid –they should actually measure what they are supposed to measure. • Reliable – the results should be the same when measured by different people in similar circumstances. • Sensitive – they should be sensitive to changes in the situation concerned. reflect small changes in health status. • Specific – they should reflect changes only in the situation concerned. • Feasible – they should have the ability to obtain data when needed. • Relevant – they should contribute to the understanding of the phenomenon of interest.
- 8. USES OF INDICATORS OF HEALTH • Measurementof 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. • Evaluation of health services. • Planning and allocation of health resources. • Measurement of health successes.
- 9. CLASSIFICATIONOF INDICATORS § MortalityIndicators § Morbidity Indicators § Disability Rates § Nutritional Indicators § Health Care Delivery Indicators § Utilization Rates § Indicators of SocialAnd Mental Health § Environmental Indicators § Socio-economic Indicators § Health Policy Indicators § Indicators of Quality of Life § Other Indicators 9
- 11. Crude Death Rate •CDR 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 influencedby the age-sex composition of the population, socioeconomic and socio-cultural environment of the communities. CDR India – 6.3 deaths/1,000 population, 7.4 deaths/1,000 population (SRS 2017)
- 13. Expectation of life •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. • Highly influenced by the infant mortality rate where that is high. • Estimated for both sexes separately. • Good indicator of socioeconomic development • Life expectancy at birth: male: 67.4 years female: 70.2 years (Source: National Health Profile 2019)
- 14. 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 & socioeconomicconditions. • Sensitive indicator of availability, utilization &effectiveness of health care, particularly perinataland postnatal care. • Current IMR :India - 33/1000live births, Odisha - 41/1000live birth (SRS 2017)
- 16. Child Death Rate üThenumber of deaths at ages 1-4yrs , per 1000 children in that same age group at the mid-point of the year. üCorrelates with inadequate MCH services, malnutrition, low immunization coverage and environmental factors. üMore refined indicator of the social situation in a country than infant mortality rate. 16
- 17. Under-5 Mortality rate ØDefined as annual number of deaths occurring in the under-5 age group , expressed as a rate per 1000 live births. Reflects both infant and child mortality Ø Best single indicator of social development and well- being rather than GNP per capita. Ø Current rate India - 37/1000 live births (Source: SRS 2017)
- 18. Maternal Mortality Ratio •Total of number of female deaths due to complications arising during pregnancy , childbirth or within 42 days of delivery from “puerperal causes” in an area during a given year per total number of live births in the same area and year. • Accounts for the greatest number of deaths among women of reproductive age in developing countries. • Current MMR India – 130/100000 live births Odisha – 180/100000 live births (Sorce: SRS 2017) 18
- 20. Disease Specific DeathRate is mortality rate which is computed for specific diseases. E.g. TB mortality is 22 per 100000 population per year . (Source: TB INDIA 2014 RNTCP Annual Report 2014) Proportional Mortality Rate is the proportion of all deaths attributed to the specific disease. E.g. Coronary heart disease causes 25 to 30 % of all deaths in developed world.
- 21. Case fatality rate •Measures the risk of persons dying from a certain disease within a given time period. • Measures the pathogenicity, severity or virulence of the disease. Years of potential life lost (YPLL) • Defined as one that occurs before the age to which a dying person could have expected to survive. • Based on years of life lost through premature death.
- 23. MORBIDITY INDICATORS q Morbidityis any departure subjective or objective from a state of physiologicalwell being. q Morbidity Indicators reveal the burden of ill health in a community, but do not measure the subclinical or inapparent disease states.
- 24. Incidence • The numberof new events or new cases of a disease in a defined population, within a specified period of time. • No. of new cases of specific disease during a specified time interval_____ * 1000 Population at risk during that period • E.g. Incidence of TB (new sputum+ve cases) is 176 per 100000 population per year (Source: TB INDIA 2014 RNTCP Annual Report 2014) 24
- 25. Prevalence • Refers to all current cases ( old & new) existing at a given point or period of time in a given population. • Prevalence = All current cases existing at a given point or period of time * 100 Population at risk • May be -Point prevalence -Period prevalence • Reflects the chronicityof the disease. • Uses -1)Helps to estimate the magnitude of disease & identify high risk population. 2)Useful for administrative & planning purposes. • E.g. Prevalence of TB (sputum+ve in population) is 230 per 100000 population .(Source: TB INDIA 2014RNTCP Annual Report 2014)
- 26. Results of Screening for diabetes 5 died 5 migrated 5recovered 25 cases 40 cases 960 free 20 cases 940 free 1000 women Screening 1 January 1 January 2012 31 December 2012 Incident cases during 2012 Prevalent cases on 31 December Attrition
- 27. 2. Notification ratesis calculated from the reporting to public authoritiesof certain diseases e.g. yellowfever , poliomyelitis - They provideinformationregarding geographicclustering of infections,quality of reportingsystem etc. 3. Attendancerates at OPDs and at health centers. 4. Admission,Readmission and dischargerates. 5. Duration of stay in hospital– reflects the virulenceand resistance developed by the etiological factor. 6. Spells of sickness or absence from work or school. - reflects economical loss to the community. 27
- 29. DISABILITYRATES • Disability Ratesare of two categories • Event type Indicators - number of days of restricted activity - bed disability days - work-loss days within a specified period • Person type Indicators -limitation of mobility e.g. confined to bed, confined to house, special aid in getting around. -limitation of activity e.g. limitation to perform the basic activities of daily living (ADL) e.g. eating, washing, dressing, etc.
- 30. HALE (Health AdjustedLife Expectancy) ü Life expectancy at birth but includes an adjustment for time spent in poor health. ü Number of years in full health that a newborn can expect to live based on current rates of ill-health and mortality. • HALE FOR INDIA IS 53 YEARS 30
- 31. DALYs: Disability AdjustedLife Years • It is defined as the number of years of healthy life lost due to ill-health , disability orearly death. • 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 thingsneeded to measure DALYs are - Life table of that country,to measure the losses from prematuredeaths - Loss of healthy life years resulting fromdisability; thedisability may be permanent (polio)or temporary (TB, leprosy),physical or mental. • DALY= years of life lost + years lost to disability 31
- 32. qUses 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 programmes • To compare the health status of different countries qOne DALY is one lost year of healthy life
- 33. QALY(Quality Adjusted LifeYear) • Commonly used to measure the cost effectiveness of health interventions . • Number of years of life that would be added by intervention. • Each year in perfect health is assigned a value of 1 down to a value of 0 for death. 33
- 34. Sullivan’s Index • Sullivan’sIndex refers to “expectation of life free of disability”. • Sullivan’s Index = life expectancy of the country -probable duration of bed disability and inability to perform major activities. • It is considered as one of the most advanced indicators currently available.
- 35. DISABILITY-FREE LIFE EXPECTANCY •Active life expectancy • Average number of years an individual is expected to live free of disability if current pattern of mortality and disability continue to apply.
- 36.
- 37. q Nutritional Statusis a positive health indicator. q Anthropometric measurements of pre-school children i. Weight – measures acute malnutrition ii. Height – measures chronic malnutrition iii. Mid-arm circumference - measures chronic malnutrition qHeights (sometimes weights) of children at school entry qPrevalence of low birth weight (less than 2.5 kg)
- 38.
- 39. FERTILITY INDICATORS • Crude birthrate • Fertility rate - *General fertility rate *Age specific fertility rate *Total fertility rate • Reproduction rate -*Gross reproduction rate *Net reproduction rate • Sex ratio at birth • Pregnancy rate • Abortion rate
- 40. • Birth rate : Number of live births per 1000 estimated mid-year population in a given year. •General fertility rate : Number of live birth per 1000 women in reproductive age group in a given year. • General marital fertility rate • Total fertility rate : Average no. of children that would be borne to a women if she experiences the current fertility pattern throughout her reproductive span. • Net reproduction rate (NRR) : The number of daughters a newborn girl will bear during her life time. • NRR will be 1 if 2-child norm is adopted.
- 42. Health Care Delivery Indicators • Theseindicators reflect the equity of distribution of health resources in different parts of the country and of the provision of health care. • The frequently used indicators are • Doctor-populationRatio • Doctor-nurse ratio • Population-bedRatio • Population perPHC/sub center • Population pertraditionalbirth attendant
- 43. UTILIZATION RATES q Actualcoverage is expressed as the proportion of people in need of a service who actually receive it in a given period, usually a year. q Depends on availability & accessibility of health services and the attitude of an individual towards health care system. q It gives some indication of the care needed by a population, and therefore, the health status of the population. 43
- 44. Examples 1. Proportion ofinfants who are fully immunized 2. Proportion of pregnant women who receive ANC care or have institutionaldeliveries 3. Percentage of population who adopt family planning 4. Bed occupancy ratio 5. Average length of stay 6. Bed-turn over ratio, etc.
- 45. INDICATORS OF SOCIALANDMENTAL HEALTH • As long as valid positive indicators of social and mental health are scarce, it is necessary to use indirect measures, viz. indicators of social and mental pathology. • These include rates of suicide, homicide, other crime, road traffic accident, juvenile delinquency, alcohol and substance abuse, domestic violence, battered-baby syndrome, 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. Ex. Substance abuse in orphan children
- 46. ENVIRONMENTALINDICATORS • These reflectthe 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 prevalenceof 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.
- 47. SOCIOECONOMIC INDICATORS q Thesedo not directly measure health but are important in interpreting health indicators. q These are • Rate of growth of population increase • Per capita GNP • Level of employment • Literacy rate esp: Female literacy rate • Dependency ratio • Family size • Housing – the number of persons per room • Per capita “calorie” availability q Countries with favorable socioeconomic indicators have reported less health related problems
- 48. India's literacy rateis at 74.04%. Kerala has achieved a literacy rate of 93.91%. Bihar is the least literate state in India, with a literacy of 63.82%. Orissa -73.45%
- 49. Dependency Ratio: (No. ofpersons in age group 0-14 years + No. of persons in age group 60 years or more)/ No. of persons in age group 15-59 years • Dependency Ratio gives the proportion of persons whom the persons in economically active age group need to support • Reduction in Dependency Ratio indicates a phase of population transition where a higher percentage of persons in the working age group may translate into higher per capita income for the economy • This is also called the phase where a country may benefit from ‘Demographic Dividend’ Dependency Ratio
- 50. Dependency Ratio 0 100 200 300 400 500 600 700 800 900 1000 Bihar Meghalaya UttarPradesh Jharkhand Rajasthan MadhyaPradesh Jammu&Kashmir ArunachalPradesh Uttarakhand Chhattisgarh Nagaland Assam India Mizoram Haryana Orissa Manipur Gujarat Maharashtra HimachalPradesh Kerala Punjab AndhraPradesh Karnataka Tripura WestBengal Dadra&NagarHaveli NCTofDelhi TamilNadu Sikkim Lakshadweep Puducherry Goa Chandigarh Andaman&NicobarIslands Daman&Diu DependencyRatio 2011 DependencyRatio2001 • Dependency Ratio has reduced in all the States and UTs • At the all-India level, it has reduced by 100 points compared to 2001
- 51. Dependency Ratio India : 1991 to 2011 Dependency Ratio, India 19912001 2011 794 752 652
- 52. Health Policy Indicators üSinglemost important indicator of political commitment is allocation of adequate resources. 1. Proportion of GNP spent on health services 2. Proportion of GNP spent on health related activities like water supply and sanitation & housing and nutrition 3. Proportion of total health resources devoted primary health care. 52
- 53. Indicators of Qualityof Life Physical Qualityof Life Index It consolidates: 1. Infant mortality, 2. life expectancy at age of 1yr 3. literacy. • For each component the performance of individual countryis placed on a scale of 1 to 100. • Composite index is calculated by averaging the three indicators giving equal weight to each of them. • Does not consider the GNP. 53
- 54. Human Development Index qComposite index combining indicators representing 3 dimensions: i. longevity( life expectancy at birth) ii. knowledge (mean years of schooling and expected years of schooling) iii. income (real GDP per capita in purchasing power parity in US dollars). q Placed on the 0 to 1 scale HDI for India 0.640 HDI ranking of India is 130 New Delhi, 14 September 2018 – India climbed one spot to 130 out of 189 countries in the latest human development rankings released by the United Nations Development Programme(UNDP). India’s HDI value for 2017 is 0.640, which put the country in the medium human development category. 54
- 55. As defined bythe UN Statistical Office has been divided into 12 categories: population; family formation; families& households; learning & educational services; earning activities; distributionof income, consumption & accumulation; social security & welfare services; health services & nutrition; housing& its environment;publicorder& safety; time use; leisure & culture; social stratification & mobility. Basic needs Indicators Are used by ILO and includecalorie consumption,access to water, life expectancy,deathsdue to disease, illiteracy, doctorsand nurses per population,roomsper person,GNP per capita. 55 Social Indicators
- 56.
- 57. 1. Health ForAll Indicators
- 58. 2. MILLENIUM DEVELOPMENTGOALS - Indicators • Adopted by United Nations in year 2000. • Opportunity for concerted action to improve global health. • The 8 MDGs, break down into 21 quantifiable targets that are measured by 60 indicators.
- 60. 3. SUSTAINABLE DEVELOPMENTGOALS • On 25th September 2015, the United Nations GeneralAssembly adopted the new development agenda "Transforming our world : the 2030 agenda for sustainable development". • The post-2015 framework goes beyond the MDGs. It has 17 goals and 169 targets, including one specific (3rd goal) for health with 13 targets.
- 62.
- 65. SUMMARY • Health notmeasured directly but using indicators. • Indicator should be valid, sensitive, specific, reliable, relevant and feasible. • Used in measuring, describing, comparing, identifying health needs and planning and evaluation of health services.