Indicators of health

Department of Community Medicine

1. 1 By DR. SHEFALI JAIN INDICATORS OF HEALTH

2. INDICATORS OF HEALTH 2 Indicators 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 programme are being attained.

3. WHAT IS THE NEED FOR HEALTH INDICATORS? Health indicators are required to know the health status of a community. It also help us to- to compare health status of one country with that of other. for assessment of health care need. for allocation of scarce resources. for monitoring and evaluation of health services; activities; and programme . 3

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5. Characteristics of Indicators 5 Ideal indicator should be

6. USES OF INDICATORS 6

7. CLASSIFICATION OF INDICATORS 7

8. CLASSIFICATION OF INDICATORS 8

9. MORTALITY INDICATORS 9 Crude Death Rate :- No. of death per 1000 population per year in a given community. crude death rate is 6.9 in India ( SRS 2016) Expectation of life:- Average no. of years that will be lived by those born alive into a population if the current age-specific mortality rates persist.

10. 10 Age specific death rates:- It is defined as total no. of deaths occurring in a specific age group of the population in a defined area during a specific period per 1000 estimated population of the same age group of a population in the same area during same period. Infant mortality rate:- Infant Mortality Rate is the ratio of deaths under 1 year to the total number of live births in the same year; usually expressed as a rate per 1000 live birth. IMR is 34.0 in India (SRS 2016)

11. 11 Child Death Rate:- It is defined as the number of deaths at age 1-4 yr in a given year, per 1000 children in that age group at the mid-point of the year concerned. Under -5 proportionate mortality rate:- It is the proportion of the total deaths occurring in the under-5 age group. Under-5 mortality rate in India is 47.7(2015) Adult mortality rate:- It is defined as probability of dying between the age of 15 and 60 years per 1000 population.

12. 12 Maternal mortality rate:- It is defined as annual no. of female deaths per 100000 live births from any cause related to or aggravated by pregnancy or its management. MMR in India is 174 (SRS 2015) Disease specific mortality rate:- Mortality rates can be computed for specific diseases. Proportion mortality rate:- The simplest measure of estimating the burden of a disease in the community is proportional mortality rate,i.e;the proportion of all deaths currently attributed to it.

13. 13 Case fatality rate:- Case fatality rate is calculated as number of deaths from a specific disease during a specific time period divided by number of cases of the disease during the same time period, usually expressed as per 100. Ex:- Case fatality rate of dengue is 0.33% (2014)

14. MORBIDITY INDICATORS Morbidity indicators reveal the burden of ill health in a community, but do not measure the subclinical or inapparent disease states. INCIDENCE: The number of new cases or new events of a disease in a defined population, within a specified period of time. Ex:- The incidence of tuberculosis in India is 167 per 1 lakh population per year (2014) 14

15. 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. Ex:- The prevalence of tuberculosis in India is 195 per 1 lakh population per year (2014) 15

16. 3) NOTIFICATION RATES is calculated from the reporting to public authorities of certain diseases. Ex:- Yellow fever, poliomyelitis They provide information regarding geographic clustering of infections, quality of reporting system etc. 4) ATTENDANCE RATES at OPDs and at health centers. 5) ADMISSION, READMISSION AND DISCHARGE RATES. 16

17. DISABILITY RATES Disability rates are of two categories: 17

18. DISABILITY RATES 18 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.

19. DISABILITY RATES 19 HALE is Health Adjusted Life Expectancy Based on the framework of WHO’s ICIDH (International Classification of Impairments, Disabilities, and Handicaps) Based on life expectancy at birth but includes an adjustment for time spent in poor health. It is the equivalent no. of years in full health that a newborn can expect to live based on current rates of ill-health and mortality.

20. DISABILITY RATES 20 DALY’s: Disability Adjusted Life Years. It is defined as the no. 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.

21. DISABILITY RATES 21 Two thing needed to measure DALY’s 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 temporary ( TB,leprosy ),physical or mental. DALY = years of life lost +years lost of disability

22. DISABILITY RATES 22 Uses of DALYs 1) To assist in selecting health services priorities. 2) To identify the disadvantaged groups. 3) Targeting health interventions. 4) Measuring the results of health interventions. 5) Providing comparable measures for planning and evaluating programme . 6) To compare the health status of different countries

23. DISABILITY RATES 23 QALY’s : Quality Adjusted Life Expectancy It is the most commonly used to measure the cost effectiveness of health interventions. It estimates the no. 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 1.0 down to a value of 0.0 for death.

24. NUTRITIONAL STATUS INDICATOR 24 Nutritional status is a positive health indicator. Newborn are measured for their- 1)Birth weight 2)length 3) head circumference They reflect the maternal nutritional status. Anthropometric measurements of pre-school children. 1)Weight- measures acute malnutrition 2)Height- measures chronic malnutrition 3)Mid- arm circumference- measures chronic malnutrition

25. NUTRITIONAL STATUS INDICATOR 25 Underweight: weight for age <-2SD of the WHO Child Growth Standard median. Stunting: height for age < -2SD of the WHO Child Growth Standard median Wasting: weight for height< -2SD of the WHO Child Growth Standard median Overweight: weight for height < -2SD of the WHO Child Growth Standard median

26. NUTRITIONAL STATUS INDICATOR 26 Growth monitoring of children is done by measuring weight for age , height-for-age, weight-for-age, head and chest circumference and mid-arm circumference. In adults Underweight, Obesity and Anemia are generally considered reliable nutritional indicators.

27. UTILISATION RATES 27 Utilization rates or actual rates is expressed the proportional of people in need of a service who actually receive it in given period, usually a year. It depends on availability and accessibility of health services and the attitude of an individual towards health care system. They direct attention towards discharge of social responsibility for the organization in delivery of services.

28. UTILISATION RATES 28 EXAMPLES- Proportion of infants who are fully immunized -43% (NFHS-3) Proportion of pregnant women who receive ANC care or have institutional deliveries Percentage of population who adopt family planning BED Occupancy ratio, bed turnover ratio etc.

29. INDICATORS OF SOCIAL AND MENTAL HEALTH 29 These includes 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 Example-substance abuse in orphan children

30. ENVIRONMENTAL INDICATORS 30 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 explain the prevalence of communicable diseases in a community. The other indicators are those measuring the pollution of air, water radiations, noise pollution, exposure to toxic substances in food and water.

31. HEALTH POLICY INDICATORS 31 The single most important indicator of political commitment is allocation of adequate resources. The relevant indicators are- proportion of GNP (gross national product) spent on health services. proportion of GNP spent on health related activities like water supply, sanitation, housing and nutrition. Proportion of total health resources devoted to primary health care.

32. INDICATORS OF QUALITY OF LIFE 32 Life expectancy is now less important. The quality of life has gained importance. Physical Quality of Life Index It consolidates infant mortality, life expectancy at age 1 yr, and literacy. for each component the performance of individual country is placed of 1 to 100. the composite index is calculated by averaging the three indicators giving equal weight to each of them. the result is placed on the 0 to 100 scale. the PQLI does not consider the GNP.

33. SOCIO-ECONOMIC INDICATORS 33 These indicators do not directly measure health. Nevertheless, they are of great importance in the interpretation of the indicators of health care. These includes— Rate of population increase Per capita GNP 3) Level of unemployment 4) Dependency ratio 5) Literacy rates, especially female literacy rates 6) Family size 7) housing; the number of persons per room, and 8) Per capita “calorie” availability.

34. OTHER INDICATORS 34 SOCIAL INDICATORS: UN Statistical Office POPULATION WELFARE SERVICES FAMILY FORMATION HEALTH SERVICES FAMILIES AND HOUSEHOLD LEARNING NUTRITION EARNING ACTIVITES HOUSING AND ITS ENVIRONMENT DISTRIBUTION OF INCOME PUBLIC ORDER AND SAFETY CONSUMPTION AND ACCUMULATION OF INCOME TIME USE; LEISURE AND CULTURE SOCIAL SECURITY SOCIAL STRATIFICATION

35. 35 “ HEALTH FOR ALL” INDICATORS : For monitoring progress towards the goal of health for all by 2000AD ,the WHO listed the following four categories of indicators. 1) HEALTH POLICY INDICATORS 2) SOCIAL AND ECONOMIC INDICATORS Political commitment to “Health For All” rate of population increase Resource allocation GNP and GDP the degree of equity of distribution of health services Income distribution community involvement work condition organizational framework and managerial process adult literacy rate housing Food availability

36. 36 3) Indicators for the provision of health care 4) Health status indicators availability low birth weight accessibility infant mortality rate utilization child mortality rate quality of care life expectancy at birth maternal mortality rate disease specific mortality morbidity- incidence and prevalence

37. 37 MILLENNIUM DEVELOPMENT GOALS-INDICATORS:

38. 38 GOAL:1. Eradicate extreme poverty and hunger . INDICATOR: 4. Prevalence of underweight children under five of age. 5. proportion of population below minimum level of dietary energy consumption. GOAL:4. Reduce child mortality. INDICATOR: 13. Under 5 mortality rate 14. Infant mortality rate

39. GOAL:5. Improve maternal health 16. Maternal mortality ratio 17. Proportional of birth attended by skilled health personnel GOAL:6. Combat HIV/AIDS, malaria and other diseases 18. HIV prevalence among young people aged 15 to 24 years 19. Condom use rate of the contraceptive prevalence rate 20. Number of children orphaned by HIV/AIDS 39

40. 21. Prevalence and death rates associated with malaria. 22. Proportion of population in malaria risk areas using effective malaria prevention and treatment measures 23. Prevalence and death rates associated with tuberculosis. 24. Proportion of tuberculosis cases detected and cured under DOTS GOAL: 7. Ensure environmental sustainability 29. Proportion of population using solid fuel 30. Proportion of population with sustainable access to an improved water source, urban and rural 40

41. GOAL:8 DEVELOP A GLOBAL PARTNERSHIP FOR DEVELOPMENT Indicator:46. Proportion of population with access to affordable essential drugs on a sustainable basis. 41

42. REFERENCES 42 K. Park , Park’s Textbook Of Preventive And Social Medicine, M/S Banarsidas Bhanot Publishers, 25 th Edition,2019 AM Kadri, IAPSM’s Textbook Of Community Medicine, Jaypee Brothers Medical Publishers, 1 st Edition. 2019 Roger Detels Et Al, Oxford Textbook Of Global Public Health, Oxford, 6 th Edition

43. THANK YOU 43