Measurement of Health Status -- Health Indicators Mostafa Elkhwaas

Indicators are required to: Classification of Health

Indicators
• Measure health status of a community
• Compare health status of a country with another 1. Mortality indicators
• Assess health needs 2. Morbidity Indicators
• Allocate scarce resources 3. Disability Rates
• Monitor and evaluate health services and programs 4. Nutritional status indicators
What is Health Indicators : They are only indication or reflection of a given situation 5. Health care delivery
indicators
• According to WHO guidelines; indicators are defined as “variables which help
6. Utilization rates
to measure changes”
7. Indicators of social and
• Used when changes can not be measured directly such as changes in health
and nutritional status mental health
• If measured sequentially, they indicate direction and speed of change and 8. Socioeconomic indicators
serve to compare different areas and groups of people 9. Environmental health
Ideal Indicators Should be : Valid , Reliable , Sensitive , Specific , Feasible , Relevant indicators
10. Health policy indicators
• Valid: should measure what they are supposed to measure 11. Indicators of quality of
• Reliable: the answers should be the same if measured by different people life
in similar circumstances
• Sensitive: should be sensitive to the situation concerned
• Specific: reflects changes only in the situation concerned
• Feasible : should have the ability to obtain the data needed
• Relevant: should contribute to understanding of the phenomenon of interest

1. Mortality Indicators

• Crude death rate: number of deaths per 1000 population per year in a given community
• Expectation of life: average number of years that will be lived by those borne alive if the current age -specific
mortality rate persists
• Infant mortality rate: the ratio of death under one year of age to the total number of births in the same year; usually
expressed as a rate per 1000 live births
• Child mortality rate: number of deaths at ages 1-4 years in a given year per 1000 children in the same age group at
mid-point of the year concerned
• Under 5 proportionate mortality rate: proportion of the total deaths occurring in under-5 age group
• Maternal “puerperal” mortality rate: number of deaths due to maternal causes to number of live births
➢ Accounts for greatest proportion of deaths among women in reproductive age in developing countries
➢ Official statistics are not always accurate
• Disease-specific mortality rate: deaths due to specific diseases to total number of mid-year population
• Proportional mortality rate: number of deaths due to specific disease to total number of deaths. Measures burden of
a specific disease in the community

2. Morbidity Indicators

Counts Proportions
• Refers to the number of cases of a disease or • Persons included in the numerator are always
other health phenomenon being studied i.e. Number of included in the denominator:
cases COVID_19 in Ismailia in March 2021 A
• Can be useful for allocation of health resources Proportion: --------
• Limited usefulness for epidemiologic purposes A+B
without knowing size of the source population • Indicates the magnitude of a part, related to the
total. In epidemiology, tells us the fraction of the
population that is affected.
 Ratios Rates
• Like a proportion, is a fraction, BUT without a • A ratio in which TIME forms part of the
specified relationship between the numerator and denominator
denominator • Epidemiologic rates contain the following elements:
• Example: Occurrence of Major Depression • health issue frequency (in the numerator)
Female cases = 240 240 • unit size of population
female to male ------------------------ = ---- 2:1 • time period during which an event occurs
Male cases = 120 120
Incidence • Prevalence: is another major measure of disease in
The development of new cases of a disease that the population
occur during a specified period of time in previously • It quantifies the “burden” of disease
disease-free or condition-free (“at risk”) individuals.
others

Notification rate , Attendance rate at outpatients or Health centers , Admission and discharge rates , Average duration of
stay at a hospital , Absence from work or school

3. Disability Rates : Based on the notion that health implies a full range of daily activities :

A. Event-type Indicators

Number of days of restricted activity , Bed disability days , Work loss days or school loss days within a specified period

B. Person-type Indicators

Limitation of activity: limitation to perform the basic activities of daily living; washing, dressing, ability to work, …

Sullivan’s Index : Expectation of life free of disability

• Subtract from the life expectancy the probable duration of bed disability and inability to perform major activities
• Obtained by data from cross-sectional surveys of the population

HALE (Health Adjusted Life Expectancy)

• Based on life expectancy at birth but includes an adjustment for time spent in poor health
• Easily understood as the equivalent number of years in full health that a new born can expect to life based on
current rates of illness, health and mortality

DALY (Disability-Adjusted Life Years) : One DALY is one lost year of a healthy life , Express years of life lost to premature
death and years lived with disability

4. Nutritional Status Indicators

• Prevalence of low birth weight ( less than 2.5 kg)

• Anthropometric measures of preschool children; weight, height, mid-arm circumference
• Heights at school entry

5. Health Care Delivery Indicators

Doctor-population ratio , Doctor-nurse ratio , Population-hospital beds ratio , Population per health center , Population per
traditional birth attendants

These indicators reflects the equity of distribution of health resources in different parts of a country and of the provision of
health care

6. Utilization Rates

• Expressed as the proportion of people in need of a service who actually receive it in a given period, usually a year
• Indicates the health care needed by the population, therefore reflects health status
• A relationship exists between utilization of health care, and health needs and health status
 Examples of Utilization Rates

• Proportion of infants who are fully immunized against the EPI diseases
• Proportion of pregnant women who receive antenatal care
• Percentage of population using the various methods of family planning
• Bed-occupancy rate
• Average length of stay

7. Indicators of Social and Mental Health

• Valid positive indicators are rare

• Indirect indicators are usually used as indicators of social and mental pathology such as:

Suicide rate , Homicide rate , Road traffic accidents , Alcohol and drug abuse , Juvenile crime , Family violence, Child abuse

8. Environmental Indicators

Reflects the quality of physical and biological environment

Pollution of air and water , Radiation , Solid wastes , Noise , Exposure to toxic substances , Proportion of people having save
water and sanitation facilities

9. Socioeconomic Indicators : Do not directly measure health

Rate of population increase , Per capita GNP , Level of unemployment , Dependency ratio , Literacy rate and female literacy
rate , Family size

10. Health Policy Indicators

• Single most important indicator : Allocation of adequate resources

• Relative Indicators:* Proportion of GNP spent on health services , *Proportion of GNP spent on health related
activities “water supply, housing, nutrition, sanitation” , ,, *Proportion of total health resources spent for PHC

11. Indicators of Quality of Life

• Quality of life is difficult to define and even more difficult to measure

• Various attempts have been made to reach one composite index
• Physical Quality of Life Index is one such index, it consolidates
➢ Infant mortality , Life expectancy at age 1 , Literacy

Quality Adjusted Life Years “QALYs”

• Composite measure of health status covering both dimensions of quality and quantity
• If a person lives in perfect health for one year, that person will have 1 QALY (1 Year of Life × 1 Utility Value = 1 QALY)
• If a person lives in perfect health but only for half a year, that person will have 0.5 QALYs.
(0.5 Years of Life x 1 Utility Value = 0.5 QALYs)
• Conversely, if a person lives for 1 year in a situation with 0.5 utility (half of perfect health), that person will also have
0.5 QALYs. (1 Year of Life x 0.5 Utility Value = 0.5 QALYs)

12. Other Classification of Indicators United Nations

A. Social indicators such as: Learning and educational services , Distribution of income , Social security and welfare services

B. Basic needs indicators such as: Calorie consumption , Access to safe water , Illiteracy

C. Health for All indicators : Health policy indicators , Social and economic indicators related to health , Indicators for
provision of health care , Health status indicators

D. Millennium Development Goal Indicators : Developed by UN to improve global health , Has eight goals, eighteen targets,
and forty eight indicators