1. IntroductionMethods & MaterialsResults Comments and Conclusions Health Indicators (HI) are one of the key elements of health information systems summarising processes about data, information, knowledge and decision-making. An indicator is a parameter calculated by statistical techniques which condenses information about specific aspects or cluster data. Comparisons across HI sets are vital for benchmarking across countries. The objectives are to compare international HI system from WHO (Genève, Copenhagen, Washington DC, other), EU (ECHI initiative), OCDE, UUNN, and, use this comparison as a basis for identifying a set of common items which could therefore be recommended as core for health information comparisons. First, we use descriptive methods for a revision of HI systems, using accessible and available information through electronic on-line tools at the World Wide Web. In particular, the web pages of EU-ECHI, WHO, PAHO/WHO, EURO/WHO, OCDE and UN-MDG have been checked. Second, drawing from this comparative exercise we describe a set of 30-40 common items that were considered to be essential to the development of a regional/local set of indicators.. We can see in Table 1 the number of countries (“Countries and Territories”), Health Indicators (HI) and the categories of HI in Different International Organizations considered in this work. In these 8 options the number of countries differ between 27 and 193; also the number of HI varies between 10 to 214. Finally, the number of categories or domains or groups of HI fluctuates from 4 to 10. Table 2 shows Number of Health Indicators (HI) by Categories or Domains of HI in Different International Organizations. Considering these six International Organizations we observe 34 categories of HI, some of them are the same but others are different. Table 3 presents a proposed Short List of Health Indicators by Main Categories or Domains. There are 41 HI grouped by 6 main categories. As an example, “Life expectancy at birth” that remains in this proposal in the 2nd Group (“Health status: Mortality and Burden of disease”) but it is possible to put it in the first group of this list. Criteria to decide this proposed list are related to clear definitions of HI, relevant to consensus in international perspective and availability of data. HI classifications differ internationally, as well as internal categories and subcategories. This paper shows different types of variability in HI. International Organizations have to build a process of consensus about HI try to minimize the variability of conceptual frameworks, classifications and terminologies, definitions, collected uniform data, usability of this type of information, benchmarking and dissemination applications. This process is ongoing but we need more discussions to reach a consensus. In this context, we propose this Short List of Health Indicators by Main Categories or Domains. This is the first step to discuss this topic in order to develop a core, useful and practical list for everyone, not only for international organisations but also regions, countries and different subnational levels. Health indicators system in an international comparison Canela-Soler J, Loyola-Elizondo E, Cornet-Prat J, Manyach-Serra J, Guanyabens-Calvet J, Constante Beitia C. Abstract Health Indicators (HI) are one of the key elements of health information systems. We use descriptive methods for a review of HI systems of EU-ECHI, WHO, PAHO/WHO, EURO/WHO, OCDE and UN-MDG. In this context, we propose a Short List of Health Indicators by Main Categories or Domains as a starting point for discussions and consensus. 29 October-4 November 2011 Cape Town, South-Africa D045p Table 1. Number of Countries, HI and Categories of HI in Different International Organizations Organizations Num. of countries* Num. of HI** Num. of categories EU-ECHI27404 WHO1931646 PAHO/WHO481325 EURO/WHO532148 OECD - Health at Glance 2009 34677 OECD – Health Data 2011 34535 OECD – Health Stat 346210 UN-MDG193106 *Countries and territories ** HI = Health Indicators Categories or Domains EU-ECHIWHOPAHOEUROOECDUN-MDG Demographi cs 12 Demographi cs and socioeconom ic factors 8 Socioeconom ic factors 12 Demographi cs and socioeconom ic statistics 15 Health service coverage 20 Health status 14 13 Health systems resources 31 Inequities in health care and health outcomes 36 Mortality and burden of disease 39 Risk factors 23 Health determinant s 5 Health intervention s and health services 13 Mortality 43 Morbidity and risk factors 32 Access, resources and health services coverage 33 Mortality- based indicators 60 Morbidity, disability and hospital discharges 47 Lifestyles 12 Environmen t 10 Health care resources 22 Health care utilization and costs 27 Maternal and child health 21 Non-medical determinant s of health 7 Health workforce 12 Health care activities 10 Quality of care 11 Access to care 7 Health expenditure and financing to care 7 MDG1 1 MDG4 2 MDG5 1 MDG6 4 MDG7 1 MDG8 1 TOTAL401641322146710 Table 2. Number of Health Indicators (HI), Categories or Domains of HI in Different International Organizations Table 3. Proposal Short List of Health Indicators by Main Categories or Domains Demographic and socio-economic characteristics 1.Total population 2.Population living in urban areas (%) 3.Crude death rate per 1000 population 4.Live births per 1000 population 5.Gross national income per capita (PPP international $) 6.Total expenditure on health as % of GDP (2009) 7.Total expenditure on health per capita (Intl $) 8.Expenditure on pharmaceuticals per capita (Intl $) Health status: Mortality and Burden of disease 1.Life expectancy at birth m/f (years) 2.Probability of dying between 15 and 60 years m/f (per 1 000 population) 3.Under-5 mortality rate, per 1 000 live births 4.Maternal mortality ratio, per 100000 live births 5.SDR all causes, all ages per 100000 population 6.SDR, diseases of circulatory system, all ages per 100000 population 7.SDR, external cause injury and poison, all ages per 100000 population 8.SDR, malignant neoplasms, all ages per 100000 population 9.HIV Prevalence (per 100 adults 15-49 years) 10.Tuberculoses Prevalence, per 100000 population 11.Prevalence estimates of diabetes, adults aged 20-79 years Health systems resource 1.Practising Physicians, per 1000 population 2.Practising Nurses, per 1000 population 3.Dentists, per 100000 population 4.Hospital beds, per 1000 population 5.Number of MRI units per million population Health Care Activities 1.Doctor consultations per capita 2.Hospital discharges, per 1000 population 3.Average length of stay in hospitals for acute care (days) 4.Coronary revascularization procedures, per 100 000 population 5.Caesarean sections, per 100 6.Number of cataract surgeries, per 100 000 population Health services access, coverage and quality 1.Population using improved drinking water sources, per 100 2.Population using improved sanitation facilities, per 100 3.DTP immunization among 1-year-old, per 100 4.Total public health insurance coverage, per 100 5.Asthma admission SDR, per 100000 aged 15 and over 6.In-hospital case-fatality SDR within 30 days after admission for AMI 7.Unplanned schizophrenia re-admissions SDR to the same hospital 8.% of women screened by cervical cancer, aged 20-69 Determinants of health and risk factors 1.Tobacco smoking among adults (per 100 adults 15+) 2.Alcohol consumption (per 100 adults 15+) 3.Overweight and obesity (per 100 adults 15+) Bibliographic References http://ec.europa.eu/health/indicators/echi/index_en.htm http://www.who.int/whosis/en/ http://new.paho.org/hq/index.php?option=com_content&task=view&id=24 70&Itemid=2003http://new.paho.org/hq/index.php?option=com_content&task=view&id=24 70&Itemid=2003 http://www.euro.who.int/en/what-we-do/data-and- evidence/databases/european-health-for-all-database-hfa-db2http://www.euro.who.int/en/what-we-do/data-and- evidence/databases/european-health-for-all-database-hfa-db2 http://stats.oecd.org/index.aspx?DataSetCode=HEALTH_STAT http://unstats.un.org/unsd/mdg/Default.aspx WHO - FAMILY OF INTERNATIONAL CLASSIFICATIONS NETWORK MEETING 2011