INDICATORS OF HEALTH

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.

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

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.

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

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

Mortality Indicators Crude Death Rate Infant mortality rate Child Mortality Rate Maternal Mortality Rate Disease Specific Death Rate

Year of potential life lost Year of life lost through premature death. Death which occurs before the age to which a dying person could have expected to survive (75 yrs).

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 100000 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 249 per 100000 population .

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.

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

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.

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

Health Care Delivery Indicators Equity of distribution of health resources in different parts of the country and of the provision of health care Doctor-population Ratio – 1/1700 (Norm 1/1000) Nurse-population ratio – 0.8/1000 (Norm 1/500) Doctor- nurse ratio Population-bed Ratio – 8.9/10000 Population per PHC/sub center

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

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

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