Health Indicators, Demography,

Population Estimation
 Health Indicators
• Tools used to measure objectively a specific
health concept of interest

• Usually numeric measures which help

compare the targeted or expected results of
health programs
 Types of Health Indicators
According to:
1. aspect of health being measured
2. group referred to
3. time covered by the events
4. components of the evaluation framework
 1. According to the aspect of health
being measured
• Health status indicators
– measure health outcomes and/or their risk factors

• Health service performance indicators

– measure aspects of the performance of health
services or public health programs
 2. According to the group referred to
• Crude rates
– describes the total population which is used as the
denominator in the computation

• Specific rates
– describes only a specific sub-group of the total
population being considered
 Examples
• Crude death rate (CDR)

• Age-specific death rate (ASDR)

 3. According to the time covered by
the events

• Point in time
– occurred during the specific point in time being
considered

• Period of time
– occurred over a period of time
 Examples
• Prevalence
Number of existing cases in a place at a given time
= x 100
Number of existing cases in 4 place at a given time

• Incidence
Number of new cases occuring in a place in a given period of time
= x 100
Number of new cases occurring in a place in a given period of time
4. According to the components of the
evaluation framework

• Input indicators
– resources needed to deliver the essential services to the
population or to achieve project objectives
• Output indicators
– direct products of project activities. Generally in the form
of activities and processes undertaken
• Outcome indicators
– immediate result of the services or activities implemented
• Impact indicators
– intended or unintended long-term
organizational/community changes
 Type of Indicator
Indicator
Input -Number of posters and brochures on family
planning
-Number of community volunteers trained to
conduct health education
Output -Number of couples who have seen or received the
posters
-Number of health education classes conducted
Outcome -% increase in the level of knowledge among couples
on family planning
-% increase in number of family planning acceptors
Impact -decrease in the average number of children per
family
-decrease in the population growth rate
 Conventional Health Status Indicators
• Measures of Morbidity

• Measures of Mortality

• Measures of Fertility
 Computing Indicators

• Absolute numbers
• Ratios
• Proportions
• Rates
 Computing Indicators
Absolute Numbers
• simple count of the number of persons,
houses or events being considered
• easy to understand but difficult to interpret
especially when making comparisons among
groups with different sizes
Cases of measles of schoolchildren in Provinces
A and B
Province Number of measles cases of schoolchildren

A 450

B 200

Province Number of measles cases Total number of % of school children

of schoolchildren schoolchildren infected with measles
A 450 800 56.25%

B 200 250 80.0%

Ratio
• result of dividing one number by another
• reserved for measures wherein the numerator is not
part of the denominator
– example:
• sex ratio

Proportion
• special kind of ratio wherein the numerator is part of
the denominator
• When multiplied by 100 – called as percentage
– example:
• % of infants who are full immunized
• % of households with sanitary toilets
Rate
• measures how fast an event occurs over time
or space
• expressed in terms of the frequency of
occurrence of events
• common example in health is the incidence
rate of a disease.
Formula for Rate, Ratio and Proportion
!
= x k
"

– a: # of persons or events being considered

– b: size of the group to which the number in the numerator
is being related to
– k: factor (100, 1000, 10000, 100000 or even 1M)
• To make the resulting number easier to interpret
 Demography
• The scientific study of human populations
– Population size
– Population structure/composition
– Population distribution in space

• “Study of the size, territorial distribution, and

composition of the population, changes therein, and
the components of such changes”
Hauser and Duncan (1959:2)
 A. Population Size
• Affected by:
– Natality
– Mortality
– migration
2 Methods of Population Allocation
A. De Facto Method: people are counted or
allocated to the area where they were physically
present at the time of the census

B. De Jure Method: people are counted or

allocated to the place of their usual residence
 B. Population Composition
• Determines the number of percentage of the
population according to the categories of
important socio-demographic-economic
variables

• The most basic description of the population

composition is according to age and sex.
 Factors Affecting Population
Composition
• Birth rate: # of births per 1000 population
• Death rate: # of deaths per 1000 population
• Emigration: number of people leaving a
country
• Immigration: number of people moving to a
country
 Describing the Age Composition of a
Population
• Median Age: the age below which we have 50%
of the population

• Age dependency ratio: indicator of age-induced

economic drain on human resources
– Children (0-14yo)
– Elderly (≥65yo)
– Computed as the ratio of the dependents to the
economically active group (15-64) of the population
 Describing the Sex Composition of a
Population
• Sex ratio: computed by dividing the number of
males by the number of females using a factor
of 100
• Interpreted as the number of males for every
100 females in the population
 The Population Pyramid
• Graphical presentation of the age and sex
structure of a population
• Special type of histogram: male population is
shown at the left and females at the right
– Youngest age group is the base and the oldest is
the top

• Either the actual population count or he

percentage of the population can be graphed.
 C. Population Distribution
• Description of how people are distributed in a
specified space or geographic area
• Affected by:
– Physical
– Political
– Social/Cultural
– Economic
• Indicators:
– Population density
– Crowding index
 Population Estimation

• Computation of future changes in population

numbers, given certain assumptions about
future trends in the rates of fertility, mortality
and migration
 Purposes of Population Estimates
• For analysis of various trends
• For measuring shifts in population
• For determining allocation of public funds or
political representation in the government
• For planning
 Measures of Changes in Population
Size
A. Natural increase
B. Rate of natural increase
C. Relative increase
D. Absolute increase per year (b)
E. Annual rate of growth (r)
A. Natural Increase
• Natural increase in a specific place and time
= number of births – number of deaths
• Example:
– Determine the natural increase in 2017
Year 2017
Births 1,761,602
Deaths 531,280

• 1,761,602 – 531,280 = 1,230,322

B. Rate of Natural Increase
• Rate of natural increase in a specific place and
time
= crude birth rate (CBR) – crude death rate (CDR)

• natural increase expressed as rate

C. Relative Increase
• Actual difference between 2 census counts
expressed in percent relative to the population
size of the prior census

• Relative increase
Pt – P0
= P x 100
0

P0 = population size at an initial time, time 0

Pt = population size at time t
D. Absolute Increase per year (b)
• Measures the average number of people
added to the population per year
Pt – P0
b= t

P0 = population size at an initial time, time 0

Pt = population size at time t
t = number of years between time 0 and time t
 Estimating Relative and Absolute
Increase
• Compute for the following given the data
below:
– Relative increase from 2010 – 2013
– Absolute increase per year from 2010 – 2013

Year Population
2010 92, 337,852
2013 98,393,574
 Estimating Relative and Absolute
Increase
Year Population
• Relative Increase 2010 92, 337,852

Pt – P0 2013 98,393,574
= x 100
P0

• Absolute increase
Pt – P0
b=
t
E. Annual Rates of Growth (r)
• Also utilize results of 2 censuses to quantify
the amount of change in population size
• Assumes that the population is changing at a
constant rate per year
 Method of Estimation
• Take into account all the operations that can
affect population size

• Component Method
• Mathematical Method
 A. Component Method
• Also known as inflow-outflow or balancing
equation method

• Pt = Po + (B – D) + (I – O)

– B: births in the interval 0 and t

– D: deaths in the interval 0 and t
– I: immigration between 0 and t
– O: out-migration between 0 and t
 B. Mathematical Method
• Arithmetic method: assumes equal change
every year
• Geometric method: assumes that the
population changes at the same rate over
each unit
• Exponential method: assumes a constant rate
of change (r) and population is increasing
continouosly
 Estimating Rate of Change (r)
• Exponential

r = In (Pt / P0) / t x100

– Pt : future population
– P0 : past population
– t: time elapsed
 Estimating Future Population (Pt)
• Exponential

Pt = P0 ert

– P0 : past population
– t : time elapsed
– r : rate of change
– e : constant equivalent to 2.71
Estimating Past Population (P0)
• Exponential
Pt
P0 = rt
e

Estimation of the amount of time (t)

• Exponential
In (Pt /Po)
t=
r
 Example
• Given below is the Philippine census information in 1995
and 2000. Using the data, estimate the following:
1. Rate of change
2. July 1, 2005 population
3. December 25, 1997 population
4. time to reach 100, 000, 000 population
Year 1995 2000
Census date Sept. 1, 1995 May 1, 2000
Population 68, 616, 538 76, 504, 077
LB 1, 766, 440 1, 645, 043
Deaths 324, 737 366, 931
CBR 25.74/1000 21.50/1000
CDR 4.73/1000 4.80/1000
Thank you…