3 Indicators of Health

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INTRODUCTION
• There has been some confusion over terminology: health indicator as compared to
health index (plural: indices or indexes)
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• It has been suggested that in relation to health trends, the term indicator is to be
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preferred to index, whereas health index is generally considered to be an
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amalgamation of health indicators
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CHARACTERISTICS OF INDICATORS
1. Should be valid, i.e., they should actually measure what they are supposed to
measure;
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2. Should be reliable and objective, i.e., the answers should be the same if measured
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by different people in similar circumstances;
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3. Should be sensitive, i.e., they should be sensitive to changes in the situation
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concerned,
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4. Should be specific, i.e., they should reflect changes only in the situation
concerned,
5. Should be feasible, i.e., they should have the ability to obtain data needed, and;
CHARACTERISTICS OF INDICATORS contd…

6. Should be relevant, i.e., they should contribute to the understanding of the
phenomenon of interest
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INDICATORS OF HEALTH
• To measure health status
• To compare
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• To assess the health needs
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• To plan & implement
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• To evaluate health care
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INDICATORS OF HEALTH-CLASSIFICATION
• Mortality indicators • Indicators of social and mental health
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• Morbidity indicators • Environmental indicators
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• Disability rates • Socio-economic indicators
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• Nutritional status indicators • Health policy indicators
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• Health care delivery indicators • Indicators of quality of life, and
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• Utilization rates • Other indicators
1. MORTALITY INDICATORS
1. Crude death rates :
• It is defined as the number of deaths per 1000 population per year in a given
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community
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• When used for international comparison, the usefulness of the crude death rate is
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restricted because it is influenced by the age-sex composition of the population
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• A decrease in death rate provides a good tool for assessing the overall health
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improvement in a population
1. MORTALITY INDICATORS contd…

2. Expectation of life:
• Life expectancy at birth is "the average number of years that will be lived by those
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born alive into a population if the current age-specific mortality rates persist“
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• Life expectancy at birth is used most frequently
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• It is estimated for both sexes separately
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• An increase in the expectation of life is regarded, inferentially, as an improvement
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in health status
• It has been adopted as a global health indicator.

3. Age-specific death rates :
• Death rates can be expressed for specific age groups in a population which are
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defined by age
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• An age-specific death rate is defined as total number of deaths occurring in a
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specific age group of the population (e.g. 20-24 years} in a defined area during a
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specific period per 1000 estimated total population of the same age group of the
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population in the same area during the same period

4. Infant mortality rate :
• Infant mortality rate is the ratio of deaths under 1 year of age in a given year to the
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total number of live births in the same year; usually expressed as a rate per 1000
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live births
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• It is one of the most universally accepted indicators of health status not only of
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infants, but also of whole population and of the socioeconomic conditions under
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which they live
• In addition, the infant mortality rate is a sensitive indicator of the availability,

utilization and effectiveness of health care, particularly perinatal care

5. Child mortality rate :
• Another indicator related to the overall health status is the early childhood (1-4
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years) mortality rate
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• It is defined as the number of deaths at ages 1-4 years in a given year, per 1000
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children in that age group at the mid-point of the year concerned
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• Apart from its correlation with inadequate MCH services, it is also related to
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insufficient nutrition, low coverage by immunization and adverse environmental
exposure and other exogenous agents

6. Under-5 proportionate mortality rate :
• It is the proportion of total deaths occurring in the under-5 age group
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• This rate can be used to reflect both infant and child mortality rates.
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• In communities with poor hygiene, the proportion may exceed 60 per 1000 live
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births
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• In some European countries, the proportion is less than 2 per 1000 live births
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• High rate reflects high birth rates, high child mortality rates and shorter life
expectancy

7. Adult mortality rate :
• The adult mortality rate is defined as the probability of dying between the age of 15
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and 60 years per 1000 population
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• The probability of dying in adulthood is greater for men than for women in almost
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all countries, but the variations between countries is very large
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• In Japan, less than 1 in 10 men (and 1 in 20 women) die in these productive age
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group, compared to almost 2-3 in 10 men (and 1-2 women) in Angola

8. Maternal {puerperal} mortality rate :
• Maternal {puerperal} mortality accounts for the greatest proportion of deaths
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among women of reproductive age in most of the developing world
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• There are enormous variations in maternal mortality rate according to country's
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level of socioeconomic status
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9. Disease-specific mortality rate :
• Mortality rates can be computed for specific diseases.
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• As countries begin to extricate themselves from the burden of communicable
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diseases, a number of other indicators such as deaths from cancer, cardiovascular
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diseases, accidents, diabetes, etc have emerged as measures of specific disease
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problems.
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10. Proportional mortality rate :
• The simplest measure of estimating the burden of a disease in the community is
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proportional mortality rate, i.e., the proportion of all deaths currently attributed to
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• For example, coronary heart disease is the cause of 25 to 30 per cent of all deaths
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in most western countries
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• The proportional mortality rate from communicable diseases has been suggested as
a useful health status indicator; it indicates the magnitude of preventable mortality
11. Case fatality rate :

• Case fatality rate measures the risk of persons dying from a certain disease within a
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given time period
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• Case fatality rate is calculated as number of deaths from a specific disease during a
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specific time period divided by number of cases of the disease during the same time
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period, usually expressed as per 100
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• The case fatality rate is used to link mortality to morbidity
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• One function of the case fatality rate is to measure various aspects or properties of a
disease such as its pathogenicity, severity or virulence
• It can also be used in poisonings, chemical exposures or other short-term non-

disease cause of death
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12. Years of potential life lost (YPLL) :
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• Years of potential life lost is based on the years of life lost through premature death
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• It is defined as one that occurs before the age to which a dying person could have
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expected to survive (before an arbitrary determined age, usually taken age 75 years)
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• A 30 year old who dies in a road accident could theoretically have lived to an average
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life expectancy of 75 years of age; thus 45 years of life are lost
2. MORBIDITY INDICATORS
• Incidence rate
• Prevalence rate
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Notification rate
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Out patients attendance rate
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•
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Hospital admission rate
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• Duration of stay in the hospital
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3. DISABILITY RATES
• Since death rates have not changed markedly in recent years, despite massive
health expenditures, disability rates related to illness and injury have come into use
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to supplement mortality and morbidity indicators
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• Event type - No of days of restricted activity
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- Bed disability days
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- Sickness absenteeism
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Person type - Limitation of mobility
- Limitation of daily activity
4. NUTRITIONAL STATUS INDICATORS

• Anthropometric measurements of preschool children, e.g., weight and height, mid-
arm circumference;
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• Heights (and sometimes weights) of children at school entry; and
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• Prevalence of low birth weight {less than 2.5 kg)
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5. HEALTH CARE DELIVERY INDICATORS

• Doctor : Population. 1:2500
• Nurse: Population 1:5000
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Health worker: Population 1:3000
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Sub centers: Population 1:3000
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P H C : Population 1:30000
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6. INDICATORS OF SOCIAL & MENTAL HEALTH

• Rates of crimes - murder, theft, suicides, homicides, prostitution, gambling, juvenile
delinquency; alcohol and drug abuse; smoking; consumption of tranquillizers;
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obesity
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Rates of accidents
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• Rate of divorces, family violence
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• Battered baby and battered-wife syndromes and neglected and abandoned youth
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in the neighborhood
7. SOCIOECONOMIC INDICATORS
• Growth rate of population
• Per capita income / GNP
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Percentage of people below poverty line
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Level of unemployment
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Dependency ratio
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• Literacy rate
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• Family size
8. HEALTH POLICY INDICATORS

• Proportion of the budget (NGP) spent on Health services— Reproductive and Child
Health, Revised National Tuberculosis Control Programme, Integrated Child
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Development Services, Pulse polio programme
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• Proportion of GNP spent on health related activities (including water supply and
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sanitation, housing and nutrition, community development), and
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• Proportion of total health resources devoted to primary health care
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9. ENVIRONMENTAL INDICATORS
• Indicators relating pollution of air, water, noise, soil, radiation solid waste
• Percentage of houses having safe water supply, adequate sanitary facilities
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Thus there is no single comprehensive indicator to assess or to measure the health
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status of country
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• Each indicator reflects one aspect of health
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•
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Ideal indicator is yet to be developed
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• Thus there is no single comprehensive indicator to assess or to measure the health
status of country
10. UTILIZATION RATES

a. proportion of infants who are "fully immunized“ against the 6 EPI diseases.
b. proportion of pregnant women who receive antenatal care, or have their deliveries
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supervised by a trained birth attendant
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c. percentage of the population using the various methods of family planning
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d. bed-occupancy rate {i.e., average daily in-patient census/average number of beds).
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e. average length of stay (i.e., days of care rendered/ discharges), and
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f. bed turnover ratio (i.e., discharges/average beds)

3 Indicators of Health

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LastBenchPharmacist.blogspot.

CHARACTERISTICS OF INDICATORS contd…

• Mortality indicators • Indicators of social and mental health

1. MORTALITY INDICATORS contd…

• It has been adopted as a global health indicator.

1. MORTALITY INDICATORS contd…

1. MORTALITY INDICATORS contd…

• In addition, the infant mortality rate is a sensitive indicator of the availability,

1. MORTALITY INDICATORS contd…

1. MORTALITY INDICATORS contd…

• It is the proportion of total deaths occurring in the under-5 age group

1. MORTALITY INDICATORS contd…

1. MORTALITY INDICATORS contd…

• Maternal {puerperal} mortality accounts for the greatest proportion of deaths

1. MORTALITY INDICATORS contd…

1. MORTALITY INDICATORS contd…

• The simplest measure of estimating the burden of a disease in the community is

11. Case fatality rate :

• It can also be used in poisonings, chemical exposures or other short-term non-

life expectancy of 75 years of age; thus 45 years of life are lost

- Limitation of daily activity

4. NUTRITIONAL STATUS INDICATORS

5. HEALTH CARE DELIVERY INDICATORS

• Nurse: Population 1:5000

6. INDICATORS OF SOCIAL & MENTAL HEALTH

• Per capita income / GNP

8. HEALTH POLICY INDICATORS

• Percentage of houses having safe water supply, adequate sanitary facilities

10. UTILIZATION RATES

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