INDICATORS OF HEALTH

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Presented By: Narendra Singh PG JR1 Department of Community Medicine

Health “A state of complete physical, mental & social

wellbeing, and not merely an absence of disease or infirmity” (WHO).

Amplified to include the ability to lead a “socially and economically productive life”

Health cannot be measured in exact measurable forms. illness (or lack of health), consequences of ill-health

(morbidity, mortality) & economic, occupation & domestic factors that promote ill health.

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Indicators

WHO defines Indicators as:

“variables which measure change”

Indicators of Health

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Health Indicator is a variable, susceptible to direct measurement, that reflects the state of health of persons in a community.Indicators help to measure the extent to which the objectives and targets of a programme are being attained.

Characteristics• Valid – actually measure that they are supposed to

measure• Reliable – results should be the same when measured

by different people in similar circumstances• Sensitive – sensitive to changes in the situation

concerned• Specific – reflect changes only in the situation

concerned• Feasible – have the ability to obtain data when needed• Relevant – contribute to the understanding of the

phenomenon of interest

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Classification of Indicators of Health

Mortality Indicators Morbidity Indicators Disability Rates Nutritional Indicators Health Care Delivery

Indicators Utilization Rates

Indicators of Social And Mental Health

Environmental Indicators Socio-economic Indicators Health Policy Indicators Indicators of Quality of

Life Other Indicators

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Mortality Indicators Crude Death Rate Age Specific Death Rates Expectation of life Infant mortality rate Under-5 Proportionate Mortality rate Child Mortality Rate Maternal Mortality Rate Disease Specific Death Rate Proportional Mortality Rate Case fatality rate Year of potential life lost

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Birth rate 21.6/1000 live birth

Crude death rate(SRS 2012) 7/1000 live birth

Infant mortaility rate(SRS 2012) 42/1000 live birth

Maternal mortality ratio(2012) 178/100000 live birth

Expectation of life at birth ( census2011)

Male: 67.3 female: 69.6

Year of potential life lost

Year of life lost through premature death.Death which occurs before the age to which a dying person could have expected to survive (75 yrs).

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Morbidity IndicatorsIncidence Number of new events or cases occurring in a defined

population, during a specified period of time. Ex: Incidence of TB (new sputum+ve cases) is 168 per

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 or midway through the period.

Ex: Prevalence of TB (sputum+ve in population) is 249 per 100000 population .

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Morbidity Indicators

1. Notification rate2. Attendance rates at OPDs and at health centers.3. Admission, Readmission and discharge rates.4. Duration of stay in hospital 5. Spells of sickness or absence from work or

school.

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Disability Rates

Disability Rates are 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 - limitation of activity: basic activity of daily living

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Disability Rates

HALE (Health Adjusted Life Expectancy)

1. life expectancy at birth but includes an adjustment for time spent in poor health.•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.

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QALY(Quality Adjusted Life Year)

Commonly used to measure the cost effectiveness of health interventions .

Number of years of life added by a successful treatment or adjustment for quality of life.

Each year in perfect health is assigned a value of 1 down to a value of 0 for death.

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Disability RatesDALY (Disability Adjusted Life Years)Number of years of healthy life lost due to all causes whether from

premature mortality or disability.

MAJOR MEASURES USED ARE:( DALY = YLL+ YLD)1. YEAR OF LIFE LOST: no of death at each age multiplied

by the expected remaining years of life a/c to a global standard life expectancy.

2. Years lost to disability: no of incident cases due to injury and illness is multiplied by the average duration of disease and a weighing factor reflecting the severity of disease on a scale from 0 (perfect health) and 1(dead).

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Nutritional Status Indicators Positive health indicator

Anthropometric measurements of pre-school children

i. Weight ii. Height iii. Mid-arm circumference

Growth Monitoring of children

Prevalence of low birth weight

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Health Care Delivery Indicators

Equity of distribution of health resources in different parts of the country and of the provision of health care

Doctor-population Ratio – 1/1700 (Norm 1/1000) Nurse-population ratio – 0.8/1000 (Norm 1/500) Doctor- nurse ratio Population-bed Ratio – 8.9/10000 Population per PHC/sub center

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The present doctor-population ratio is 0.5 per 1,000 and the target by 2025 is 0.8 per 1,000.

Total medical colleges:387 181 government 206 private sector. India produces 30,000 doctors, 18,000 specialists, 30,000 AYUSH graduates, 54,000 nurses, 15,000 ANMs and 36,000 pharmacists annually. Health ministry claims that there are about 6-6.5 lakh doctors available. But India would need about four lakh more by 2020 to maintain the required ratio of one doctor per 1,000 people.

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UTILIZATION RATES

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.

• Depends on availability & accessibility of health services and the attitude of an individual towards health care system

• Direct attention towards discharge of social responsibility for the organization in delivery of services

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Indicators of Social and Mental Health

Valid positive indicator are scarce, so we use indirect measures viz indicators of social and mental pathology.

Suicide, homicide, road traffic accident, juvenile delinquency, alcohol and substance abuse, domestic violence.

Guide to social action for improving the health of people.

Total no murder in 2013: 3320127

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Environmental Indicators

Reflect quality of physical and biological environment in which diseases occur and people live.

most important: that measuring the proportion of population having access to safe drinking water and sanitation facilities.

explains the prevalence of communicable diseases

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Socioeconomic Indicators

Rate of growth of population

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INDIAN DECADAL (2001 – 2011) 17.64%

INDIAN ANNUAL GROWTH 1.344%

PER CAPITA GNP Rs 54835/person

Dependency ratio 52

Literacy rates M: 82% F:65% T:74%

Family size

Housing

Per capita calorie available

Unemployment rate for India: 8.8% for 2014

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Health Policy Indicators Single most important indicator of political

commitment is allocation of adequate resources.EX:

Proportion of GNP spent on health services- 8.7%

Proportion of GNP spent on health related activities like water supply and sanitation & housing and nutrition-8.5%

Proportion of total health resources devoted primary health care.

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Indicators of Quality of Life

Physical Quality of Life IndexIt consolidates:1.Infant mortality, 2.life expectancy at age of 1yr 3.literacy.For each component the performance of individual country is 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.

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Human Development Index

composite 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).

Index= ( Actual value) –(minimum value) (Maximum value )– (minimum value)

Placed on the 0 to 1 scaleHDI for India 0.586HDI ranking of India is 135

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Multidimensional Poverty Index (MPI)India : 0.251 (2006)Reflects both the incidence or headcount ratio (H) of poverty – the proportion of the population that is multidimensionally poor – and the average intensity (A) of their poverty – the average proportion of indicators in which poor people are deprived.

Identified as poor if he or she is deprived in at least one third of the weighted indicators. MPI poor are deprived in at least 33% of weighted indicators.

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"Vulnerable to Poverty" are deprived in 20% - 33% of weighted indicators."Severe Poverty" are deprived in over 50%.

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Other Indicators Series

Health For All Indicators For monitoring the progress towards the goal of Health For All

by 2000 , the WHO has listed the following four categories of indicators.

1. Health policy indicators Political commitment to HFA Resource allocation Degree of equity of distribution of health services Community involvement Organizational framework and managerial process

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contd……

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2. Social and economic indicators related to health

• Rate of population growth

• GNP or GDP

• Income distribution

• Work conditions

• Adult literacy rate

• Housing

• Food availability

3. Indicators for the provision of health care

• Availability

• Accessibility

• Utilisation

• Quality of care

contd….

4. Health status indicators Low birth weight Nutritional status and psychosocial development of

children Infant mortality Child mortality rate (1-4yrs) Life expectancy at birth Maternal mortality rate Disease specific mortality Morbidity – incidence and prevalence Disability prevalence

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Indicators related to health:

G1 – T2; halve between 1990 and 2015 the proportion of people who suffer from hunger.

T2.I4; prevalence of underweight children (below 5yrs) from 53.4 ( 90 ) to 43.5 in 2011

T2.I5; proportion of population below minimum level of dietary of energy consumption from 25 in 1991 to 15 by 2006.

G4 – T5.I13; under-5 mortality to be reduced from 112 in 1990 to 59 in 2010.

T5.I14; infant mortality rate from 80 in1990 to 47 in 2010.

T5.I15; proportion of 1yr old children immunized for measles of 74 in 2010.

Millennium Development Goals

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Millennium Development Goals

G5 – T6; reduce maternal mortality by ¾ by 2015.

T6.116; reduce MMR from 212 by 2009.

T6.117; proportion of births attended by skilled health professional of 58 by 2011.

G6 – Combat HIV/AIDS, malaria and other diseases.Half or halted by 2015 and began to reverse the spread - reduce HIV prevalence among young people (15 – 49: 2009 = 0.3) - malaria death rate to be reduced (2011: 0.38 per lakh) - reduce TB death rate (2010: 23/lakh - reduce TB prevalence to (2011: 256)

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G7 – Ensure environmental sustainability - reduce proportion of pop using biomass fuel

to 60 by 2007 G7- T10: Half by 2015 the proportion of people

without sustainable access to safe drinking water rural area: 86

G8: develop a global partnership for development Ind:48 proportion of population with access to

affordable essential drug on a sustainable basis.

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Summary Health not measured 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

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