1. INDICATORS OF HEALTH

2. Health
“A state of complete physical, mental & social wellbeing, and not merely an absence of disease or infirmity” (WHO).
Amplified to include the ability to lead a “socially and economically productive life”
Health cannot be measured in exact measurable forms.
illness (or lack of health), consequences of ill-health (morbidity, mortality) & economic, occupation & domestic factors that promote ill health.

3. Indicators
WHO defines Indicators as:
“variables which measure change”

4. Indicators of Health
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.

5. Characteristics
Valid – actually measure that they are supposed to measure
Reliable – results should be the same when measured by different people in similar circumstances
Sensitive – sensitive to changes in the situation concerned
Specific – reflect changes only in the situation concerned
Feasible – have the ability to obtain data when needed
Relevant – contribute to the understanding of the phenomenon of interest

6. Classification of Indicators of Health
Mortality Indicators
Morbidity Indicators
Disability Rates
Nutritional Indicators
Health Care Delivery Indicators
Utilization Rates
Indicators of Social And Mental Health
Environmental Indicators
Socio-economic Indicators
Health Policy Indicators
Indicators of Quality of Life
Other Indicators

7. Morbidity Indicators Incidence Prevalence
Number of new events or cases occurring in a defined population, during a specified period of time.
Ex: Incidence of TB (new sputum+ve cases) is 168 per population per year.
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 or midway through the period.
Ex: Prevalence of TB (sputum+ve in population) is per population .

8. Morbidity Indicators Notification rate
Attendance rates at OPDs and at health centers.
Admission, Readmission and discharge rates.
Duration of stay in hospital
Spells of sickness or absence from work or school.

9. Disability Rates Event type Indicators Person type Indicators
Disability Rates are of two categories
Event type Indicators
- number of days of restricted activity
- bed disability days
- work-loss days within a specified period
Person type Indicators
- limitation of mobility
- limitation of activity: basic activity of daily living

10. HALE (Health Adjusted Life Expectancy)
Disability Rates
HALE (Health Adjusted Life Expectancy)
1. life expectancy at birth but includes an adjustment for time spent in poor health.
Number of years in full health that a newborn can expect to live based on current rates of ill-health and mortality.
HALE FOR INDIA IS 53 YEARS.

11. QALY(Quality Adjusted Life Year)
Commonly used to measure the cost effectiveness of health interventions .
Number 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 down to a value of 0 for death.

12. Disability Rates DALY (Disability Adjusted Life Years)
Number of years of healthy life lost due to all causes whether from premature mortality or disability.
MAJOR MEASURES USED ARE:( DALY = YLL+ YLD)
YEAR OF LIFE LOST: no of death at each age multiplied by the expected remaining years of life a/c to a global standard life expectancy.
Years lost to disability: no of incident cases due to injury and illness is multiplied by the average duration of disease and a weighing factor reflecting the severity of disease on a scale from 0 (perfect health) and 1(dead).

13. Nutritional Status Indicators
Positive health indicator
Anthropometric measurements of pre-school children
Weight
Height
Mid-arm circumference
Growth Monitoring of children
Prevalence of low birth weight

14. UTILIZATION RATES
Actual coverage is expressed as the proportion of people in need of a service who actually receive it in a given period, usually a year.
Depends on availability & accessibility of health services and the attitude of an individual towards health care system
Direct attention towards discharge of social responsibility for the organization in delivery of services

15. Indicators of Social and Mental Health
Valid positive indicator are scarce, so we use indirect measures viz indicators of social and mental pathology.
Suicide, homicide, road traffic accident, juvenile delinquency, alcohol and substance abuse, domestic violence.
Guide to social action for improving the health of people.
Total no murder in 2013: 33201

17. Environmental Indicators
Reflect quality of physical and biological environment in which diseases occur and people live.
most important: that measuring the proportion of population having access to safe drinking water and sanitation facilities.
explains the prevalence of communicable diseases

18. Unemployment rate for India: 8.8% for 2014

19. Indicators of Quality of Life
Physical Quality of Life Index
It consolidates:
Infant mortality,
life expectancy at age of 1yr
literacy.
For each component the performance of individual country is placed on a scale of 1 to 100.
Composite index is calculated by averaging the three indicators giving equal weight to each of them.
Does not consider the GNP.

20. Health status indicators
contd….
Health status indicators
Low birth weight
Nutritional status and psychosocial development of children
Infant mortality
Child mortality rate (1-4yrs)
Life expectancy at birth
Maternal mortality rate
Disease specific mortality
Morbidity – incidence and prevalence
Disability prevalence

21. Summary
Health not measured directly but using indicators
Indicator should be valid, sensitive, specific, reliable, relevant and feasible
Used in measuring, describing, comparing, identifying health needs and planning and evaluation of health services