Health Indicators

Introduction

Indicators are required to objectively measure the health status of a community. Indicators are also required to compare the health status of one country with that of another for the assessment of health care needs, for allocation of scarce resources and for monitoring and evaluation of health services, activities and programmes. Indicators help to measure the extent to which the objectives and targets of a health programme are being attained.

Importance of Health Indicators

The term Health Index is used as an amalgamation of health indicators. The term Health Indicator is used in relation to health trends. Health Indicators provide comprehensive data in a widely accessible format. Health Indicators are important for local follow-up leading to the Future of Public Health. Health Indicators help to monitor health status of community and health disparities.
3

Uses of Health Indicators

Health Information System (HIS) - Data about the entire community on multiple determinants of health.

For use by:

INGOs WHO, UNICEF, UNDP, FAO Ministry of Health at state and national level community-based organizations and advocates community clinics public agencies policymakers - World Bank, WHO, UNICEF, CDC general public Life Insurance and Health Insurance companies
4

Monitoring & Indicators in Public Health Sector

Public health refers to all organized measures (whether public or private) to prevent disease, promote health, and prolong life among the population as a whole.
The three main public health functions are: 1. The assessment and monitoring of the health of communities and populations at risk to identify health problems and priorities. 2. The formulation of public policies designed to solve identified local and national health problems and priorities.

3. Ensuring Equitable Distribution so that all populations have access to appropriate and cost-effective care, including health promotion and disease prevention services.
5

Valid should measure what they are supposed to measure.

Characteristics of Health Indicators

Sensitive should be sensitive to changes in the situation concerned.

Specific should reflect changes only in the situation

concerned.

Reliable should be able to measure the same by different people in similar circumstances.

Feasible should have the ability to obtain data needed

for the analysis.

Data Sources

Births, deaths and hospitalizations: State Department of Health (DOH) , Center for Health Statistics (CHS).

National Census Bureau, National Health Survey (NHS), Community Health Survey (CHS), District Health Survey (DHS).

Behavioral Risk Factor Surveillance System Survey:

CDC, NHS, CHS and DHS.

Population estimates: Department of Health (DOH) at state level and national level.
7

Data Analysis

Age-adjusted and age-specific rates calculated for death and hospitalization rates Crude and age-specific rates calculated for survey data 5- and 10-year trends assessed Demographic differences assessed Time trends assessed with test for trend (Mantel extension) Demographic differences assessed with 95% confidence intervals
8

Types of Health Indicators

Mortality indicators CDR, Life expectancy, IMR, MMR Morbidity indicators Incidence, Prevalence, Duration of hospital stay Well-being or QOL indicators PQLI, HDI Disability indicators Sullivans Index, HALE, DALY Nutritional status indicators Health care delivery indicators Utilization rates Indicators of social and mental health Environmental indicators Socio-economic indicators GDP, GNP, SES Scales Health policy indicators Other indicators - Health for All indicators, Millennium Development Goal indicators
9

A. Demographic Indicators
Total population (thousands) Surface area (thousands of sq km) Population density (per sq km) Population growth rate (%) Crude birth rate (per 1,000 population) Crude death rate (per 1,000 population) Urban population (%) Urban population growth rate (%)
10

B. Socioeconomic Indicators
Gross National Income (GNI) per capita (US$) Gross Domestic Product (GDP) per capita growth rate (%)

Average annual change in consumer price index (%)

Human Development Index (HDI)

Dependency ratio: Total Old age Young

Adult literacy rate: Total Male Female Gross primary school enrolment ratio (%) Gross secondary school enrolment ratio (%)
11

C. Health Resources Indicators

Total expenditure on health (as % of GDP) Public share to total health expenditure (%) Per capita total health expenditure (International dollars) Physicians per 10,000 population Hospital beds per 10,000 population

12

D. Primary Health Care Coverage Indicators

Infants immunized (%) DPT3 : OPV3 : BCG : Measles : Pregnant women immunized with tetanus toxoid (%) Attended by trained personnel (% of live births) Pregnant women : Deliveries : Women of child bearing age using contraceptives (%) Population with access to safe drinking water (%) Population with access to adequate sanitation (%)
13

E. Health Status Indicators

Life expectancy at birth Total : Male : Female :
Healthy life expectancy (HALE) at birth Total : Male : Female : Infant mortality rate (per 1,000 live births) Under-five mortality rate (per 1,000 live births) Total fertility rate (per woman)

Maternal mortality ratio (per 100,000 live births) Low birth weight newborns (%)
Children with low weight-for-age (%)
14

F. Gender Equity Indicators

Life expectancy at birth ratio (females as a % of males)
Gender-related development index (GDI) Gender empowerment measure (GEM) Ratio of earned income (females as a % of males) Seats held in parliament (% women) Professional and technical workers (% women) Adult literacy ratio (females as a % of males) Primary school enrolment ratio (females as a % of males) Secondary school enrolment ratio (females as a % of males)
15

Mortality Indicators

Crude Death Rate (CDR)

It indicates the rate at which people are dying. It provides a good tool for assessing the overall health improvement in a population.

The number of deaths per 1000 population per year in a given community.
Reduction in the number of deaths in the population is an obvious goal of medicine and health care.
17

Life Expectancy

It is also known as expectation of life.

The average number of years which a person of that age may expect to live, according to the mortality pattern prevalent in that country.
18

One of the best indicators of a countrys level of development and of the overall health status of its population.

A mortality indicator
Examples : - Life expectancy at birth - Life expectancy at 1 year old - Life expectancy at 5 years old.
19

Usually calculated separately for females and males, female being higher life expectancy than men with modern obstetric care.

Most often used in context of human populations, but also can be used in animal or plant ecology.
It is calculated by the analysis of life tables.
20

21

Life Expectancy based on income

22

Life Expectancy based on gender differences

23

World Life Expectancy at birth

Average: Males: Females:

67.2 years 65.0 years 69.5 years

- United Nations World Population Prospects 2006 Revision for the years 2005-2010

24

Life Expectancy in Malaysia at birth (2005-2010)

Average: Male: Female:

74.2 years 72.0 years 76.7 years

United Nations World Population Prospects 2006 Revision for the years 2005-2010

25

Time-line of Life Expectancy in Malaysia

Life expectancy at birth 71.67 72.24 72.24 72.5 72.76 73.03 73.29 Percent Change Date of Information 2003 est. 0.80 % 0.00 % 0.36 % 0.36 % 0.37 % 0.36 % 2004 est. 2005 est. 2006 est. 2007 est. 2008 est. 2009 est.

Year 2003 2004 2005 2006 2007 2008 2009

Rank 104 105 107 107 105 107 107

2010

74.20

110

1.24 %

2010 est.
26

Well-being Indicators or Quality of Life (QOL) Indicators

Physical Quality of Life Index (PQLI)

PQLI is a measure of Well-being or Quality of Life (QOL).

It measures the Well-being or Quality of Life of a country in 3 basic dimensions : 1. Life Expectancy at age one Longevity 2. Infant Mortality Rate Mortality

3. Adult Literacy Rate Education

28

Calculation of PQLI

For each component, the performance of individual countries is placed on a scale of 0 to 100, where 0 represents worst performance and 100 represents best performance.
The composite index is calculated by averaging the three indicators, giving equal weight to each of them. The resulting PQLI is also scaled between 0 to 100.

The ultimate objective is to attain a PQLI of 100.

29

Limitations of PQLI

PQLI does not take per capita GDP into consideration. It does not measure economic growth.

PQLI measures the results of social health, economic and political policies. It shows that money is not everything.

Oil-rich countries of Middle East, with high per capita GDP, have comparatively lower PQLI.

Sri Lanka and Kerala state in India have low per capita

GDP, but high PQLI.

PQLI is intended to complement, but not replace GDP.

30

Human Development Index (HDI)

HDI is a summary measure of human development.
It measures the standard of Living of a country in 3 basic dimensions :
1. Life Expectancy at Birth Longevity 2. Real GDP per capita (Purchasing Power Parity ) Income 3. Adult Literacy Rate & Gross enrolment ratio Education - It is measured by the adult literacy rate (with weight) & gross enrolment ratio (with weight)
31

Indicator
Life expectancy at birth (years) Adult literacy rate (%)

Maximum value
85 100

Minimum value
25 0

Combined gross enrolment ratio (%)

GDP per capita (PPP US$)

100
40,000

0
100

Source: UNDP (2003) Human Development Report 2003, Oxford University Press, New York.

32

Example for Calculation of HDI

life expectancy at birth 2006: adult literacy: gross enrolment ratio in education: GDP per capita PPP: 73.9years 91.5% 71.5 US$12,536

33

34

Significance of HDI
Human Development Very high High HDI Status

0.900-1.000 0.800-0.899

Developed Developing

Medium Low

0.5000.799 <0.500

Developing Least developed

Norway, Canada and USA are at the top of HDI ranking.

Niger, Sierra Leone and Ethiopia are at the bottom of HDI ranking.

35

HUMAN DEVELOPMENTAL REPORT 2009

Life expectancy at birth (years) 1. Japan (82.7) 53. Slovakia (74.6) 54. Viet Nam (74.3) 55. Malaysia (74.2) Adult literacy rate (% ages 15 and above) 1. Georgia (100.0) 60. Malta (92.4) 61. Indonesia (92.0) 62. Malaysia (91.9) Combined gross enrolment ratio (%) 1. Australia (114.2) 100. Moldova (71.6) 101. Fiji (71.5) 102. Malaysia (71.5) GDP per capita (PPP US$) 1. Liechtenstein (85,382) 59. Chile (13,880) 60. Botswana (13,604) 61. Malaysia (13,518)

HDI value

1. Norway (0.971) 64. Trinidad and Tobago (0.837) 65. Montenegro (0.834) 66. Malaysia (0.829)

67. Serbia (0.826)

68. Belarus (0.826) 182. Niger (0.340)

56. The former Yugoslav 63. Seychelles Republic of (91.8) Macedonia (74.1) 57. Syrian Arab Republic (74.1) 176. Afghanistan (43.6) 64. Jordan (91.1) 151. Mali (26.2)

103. United Arab Emirates (71.4)

104. Maldives (71.3) 177. Djibouti (25.5)

62. Argentina (13,238)

63. Turkey (12,955) 181. Congo36 (298)

Limitations of HDI

HDI does not measure the results of social health, economic and political policies.
However, HDI measures the standard of living and not only the income of a country in terms of per capita GNP.

Two countries with similar income per capita GNP can have very different HDI values and countries having similar HDI can have very different income levels in per capita GNP.
37

Disability Indicators

Sullivans Index
Definition

Expectation of life free of disability.

It is computed by subtracting from the life expectancy, the probable duration of bed disability and inability to perform major activities or Activities of Daily Living (ADL).

Sullivans index is considered to be one of the most advanced indicators currently available.
39

HALE (HealthAdjusted Life Expectancy)

Definition

HALE is the number of years in full health that a newborn can expect to live based on current rates of ill-health and mortality. HALE is Life Expectancy at Birth, but includes an adjustment for time spent in poor health. The indicator, DisabilityAdjusted Life Expectancy (DALE), has been changed to HALE.
40

DALY (DisabilityAdjusted Life Year)

Definition

DALY is the number of productive or healthy years of life lost due to premature death, morbidity or disability .
It is a measure of the burden of disease in a defined population and the effectiveness of the interventions.

41

DALYs for a disease or health condition is calculated as the sum of the Years of Life Lost (YLL) due to premature mortality in the population and the Years Lost due to Disability (YLD) for incident cases of the health condition. DALY = YLL + YLD

One DALY is one lost year of healthy life

42

Example of Calculation of DALY

The calculation of DALYs of a man who has been deaf since he was 3 and died when he was 50. Here, the expected years of healthy life is set at 80 years and disability weight of deafness is set at 0.33.

DALYs = YLL + YLD = (1 x 30) + (1 x 0.33 x 47) = 30 + 15.51 = 45.51 DALYs

43

Limitations of DALY

Weight of a year of healthy life lived in different

ages are different.

Gender gap for life expectancy varies from country to country.

Difficult to quantify the severity of each disease.

44

Thank You
45