HEALTH INDICATORS

HEALTH
 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
 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
 INDICATORS OF HEALTH
 Indicator also termed as Index or Variable is only an
indication of a given situation or a reflection of that
situation
 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 program are being attained.

 Health Index is a numerical indication of the health of a

given population derived from a specified composite

formula.
 INDICATORS

WHO defines Indicators as

“variables which measure change”

 USES OF INDICATORS OF
HEALTH
 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.

 CHARACTERISTICS OF
INDICATORS
 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
 CHARACTERISTICS OF
INDICATORS

 Specific - They should reflect changes

only in the situation concerned

 Feasible
- They should have the ability to
obtain data needed

 Relevant
- They should contribute to the
understanding of the phenomenon of interest
CHALLENGE TO MEASURE HEALTH
 Measurement of health is not simple:-
 There is no criteria for measuring health

 As happiness health cannot be defined in measurable

terms.
 Its presence or absence is subjective matter of judgment.

 So the measurement of health has been framed in terms

of illness ( or lack of health), the consequences of ill

health ( morbidity, mortality)
FACTORS INFLUENCING HEALTH
INDICATORS
 Health is multidimensional
 Each dimension is influenced by numerous factors

 Economic, occupational, cultural, educational, social

 HEALTH INDICATORS
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
 MORTALITY 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.
 Current CDR is 7.2 deaths/1,000 population

 CBR 27.2
 MORTALITY INDICATORS
 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
 Life expectancy at birth:

Total population: 65.2 years

Male: 64.3 years
Female: 66.1 years
 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.
 Current IMR – 67/1000live birth (69)
 CHILD MORTALITY RATE
 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

 Current rate – 86/1000

 Other indicators are Perinatal mortality rate, Neonatal

mortality rate, Stillbirth rate, etc.

 Correlates with inadequate antenatal care and perinatal

care
 MORTALITY INDICATORS

 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
• Current MMR – 276/100000 live births
 MORTALITY INDICATORS

 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
 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. E.g. Incidence of TB is
168 per100000 population per year.
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
 E.g. Prevalence of TB (sputum +ve in population) is 249 per 100000
population
 MORBIDITY INDICATORS
2. Notification rates is calculated from the reporting to public
authorities of certain diseases . yellow fever , poliomyelitis,
cholera, plague
They provide information regarding geographic clustering of
infections, quality of reporting system
3. Attendance rates at OPDs and at health centers.
4. Admission, Readmission and discharge rates.
5. Duration of stay in hospital – reflects the virulence and
resistance developed by the etiological factor
6. Spells of sickness or absence from work or school.
- reflects economical loss to the community
7. Hospital data constitute a basic and primary source of
information about diseases prevalent in the community.
DISABILITY RATES
The disability rates are based on the premise or notion that
health implies a full range of daily activities.
This rate are group in two
1. Event type indicator:
i. Numbers of days restricted activity.
ii. Bed disability days
iii. Work loss days
2. Person- type indicators:-
1. Limitation of mobility
2. Limitation of quality
 DISABILITY RATES
 Sullivan’s Index 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.
 HALE - Health Adjusted Life Expectancy.
• It is based on the framework of WHO
• It is based on life expectancy at birth but includes an adjustment
for time spent in poor health.
• It is the equivalent number of years in full health that a newborn
can expect to live based on current rates of ill-health and
mortality.
 DISABILITY RATES
 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.
 DISABILITY RATES
 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
 DISABILITY RATES
 Premature death – defined as one that occurs before the
age to which a dying person could have expected to
survive if he or she was a member of a standardized
mode population with a life expectancy at birth equal to
that of world longest surviving population e.g. 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.
 NUTRITIONAL STATUS
INDICATORS
 Nutritional Status is a positive health indicator.
 Newborns are measured for their
i. Birth–weight ii. Length iii. Head circumference
 They reflect the maternal nutrition status
 Pre-school children Anthropometric measurements
i. Weight – measures acute malnutrition
ii. Height – measures chronic malnutrition
iii. 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.
INDICATORS

Anthropometric measurement of children

Prevalence of low birth weight

>2.5 Kg (24%)
 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
 Doctor – population ratio :-1 : 1222

 Doctor – Nurse ratio:- 2.2 : 1

 Population – bed ratio:- 1:1701

Population per dentist:- 16,854

Population per nurse:- 2,501
 Population per health centre:- 5000-10000

 Population per TBA :- 0.47/1000

 UTILIZATION RATES
 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.
 INDICATORS OF SOCIAL AND MENTAL
HEALTH
 Ratesof 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
 ENVIRONMENTAL
INDICATORS
 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
 INDICATORS

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
 HEALTH POLICY INDICATORS
 The single most important indicator of political
commitment is allocation of adequate resources
 The relevant indicators are

 Proportion of GDP spent on health services- 0.27%

(2011-12)
 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
 INDICATORS OF QUALITY OF LIFE
 Lifeexpectancy is no longer important
 The Quality Of Life has gained its importance

Physical Quality of Life Index

 Itconsolidates 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.

 The PQLI does not consider the GDP.

INDICATORS OF QUALITY OF
LIFE

Human Development Index

 Life expectancy at birth

 Literacy rate
 Income- GDP per capita income

The resulting is placed on the 0 to 1

scale
 OTHER INDICATORS
Social indicators
Population, families, educational, earning

Basic Needs indicators

 Calories consumption, access to water,
illiteracy, Dr per population

Health for All Indicators

 SUMMARY
 Health is 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