mmmc - health indicators

8/2/2019 MMMC - Health Indicators

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HealthIndicators


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Introduction

Indicators are required to objectively measure thehealth status of a community.

Indicators are also required to compare the healthstatus of one country with that of another for the

assessment of health care needs, for allocation ofscarce resources and for monitoring and evaluation ofhealth services, activities and programmes.

Indicators help to measure the extent to which theobjectives and targets of a health programme are beingattained.

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Importance of HealthIndicators

The term Health Index is used as anamalgamation of health indicators.

The term HealthIndicator is used in relation tohealth trends.

Health Indicators provide comprehensive datain 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.

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Uses of Health Indicators

Health Information System (HIS) - Data about theentire 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 companies4


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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 ofcommunities and populations at risk to identify healthproblems and priorities.

2. The formulation of public policies designed to solveidentified local and national health problems and

priorities.

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

services.


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arac er s cs o eaIndicators

Valid should measure what they are supposed to

measure.

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. 6


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Data Sources

Births, deaths and hospitalizations: State Departmentof 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.

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Data Analysis

Age-adjusted and age-specific rates calculatedfor death and hospitalization rates

Crude and age-specific rates calculated forsurvey 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

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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 DevelopmentGoal indicators

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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 (%)

A. Demographic Indicators

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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:

TotalMale

Female

Gross primary school enrolment ratio (%)

Gross secondary school enrolment ratio (%)

B. Socioeconomic Indicators

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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

C. Health Resources Indicators

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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 (%)

D. Primary Health Care Coverage Indicators

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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 (%)

E. Health Status Indicators

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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)

F. Gender Equity Indicators

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Crude Death Rate (CDR)

It indicates the rate at which people are dying. Itprovides a good tool for assessing the overallhealth improvement in a population.

The number of deaths per 1000 population per year in a given

community.

Reduction in the number of deaths in thepopulation is an obvious goal of medicine andhealth care.

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Life Expectancy

It is also known as expectation of life.

The average number of yearswhich a person of that age may

expect to live, according to the

mortality pattern prevalent inthatcountry.

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One of the best indicators of a countryslevel of development and of the overallhealth status of its population.

A mortality indicator

Examples :

- Life expectancy at birth

- Life expectancy at 1 year old

- Life expectancy at 5 years old.

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Usually calculated separately for femalesand males, female being higher life

expectancy than men with modernobstetric care.

Most often used in context of humanpopulations, but also can be used inanimal or plant ecology.

It is calculated by the analysis of lifetables.

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Life Expectancy based on

income

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Life Expectancy based on gender differences

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World Life Expectancy at birth

Average: 67.2 years

Males: 65.0 years

Females: 69.5 years

- United Nations World Population Prospects

2006 Revision for the years 2005-2010

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Life Expectancy in Malaysia atbirth (2005-2010)

Average: 74.2 years

Male: 72.0 years Female: 76.7 years

United Nations World Population Prospects2006 Revision for the years 2005-2010

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Time-line of Life Expectancy in Malaysia

Year

Life

expectancy at

birth

RankPercent

Change

Date of

Information

2003 71.67 104 2003 est.

2004 72.24 105 0.80 % 2004 est.

2005 72.24 107 0.00 % 2005 est.

2006 72.5 107 0.36 % 2006 est.

2007 72.76 105 0.36 % 2007 est.

2008 73.03 107 0.37 % 2008 est.

2009 73.29 107 0.36 % 2009 est.

2010 74.20 110 1.24 % 2010 est.

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Well-being Indicators

orQuality of Life (QOL)

Indicators Ph i l Q lit f Lif I d


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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

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Calculation of PQLI

For each component, the performance of individualcountries is placed on a scale of 0 to 100, where 0

represents worstperformance and 100 represents

bestperformance.

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 to100.

The ultimate objective is to attain a PQLI of 100.

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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


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Human Development Index (HDI)

HDI is a summary measure of human development.

It measures the standard of Living of a country in 3 basicdimensions :

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)

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Indicator Maximum value Minimumvalue

Life expectancy at birth (years) 85 25

Adult literacy rate (%) 100 0

Combined gross enrolment ratio (%) 100 0

GDP per capita (PPP US$) 40,000 100

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

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Example for Calculation of HDI

life expectancy at birth 2006: 73.9years

adult literacy: 91.5%gross enrolment ratio in education: 71.5GDP per capita PPP: US$12,536

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Significance of HDI

Human

Development

HDI Status

Very high 0.900-1.000 Developed

High 0.800-0.899 Developing

Medium 0.5000.799 Developing

Low


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HUMAN DEVELOPMENTAL REPORT 2009

HDI valueLife expectancyat birth(years)

Adult literacyrate(% ages 15 and

above)

Combined grossenrolment ratio(%)

GDP per capita(PPP US$)

1. Norway(0.971)

1. Japan (82.7)1. Georgia(100.0)

1. Australia(114.2)

1. Liechtenstein(85,382)

64. Trinidad andTobago (0.837)

53. Slovakia(74.6)

60. Malta (92.4)100. Moldova(71.6)

59. Chile(13,880)

65. Montenegro(0.834)

54. Viet Nam(74.3)

61. Indonesia(92.0)

101. Fiji (71.5)60. Botswana(13,604)

66. Malaysia(0.829)

55. Malaysia(74.2)

62. Malaysia(91.9)

102. Malaysia(71.5)

61. Malaysia(13,518)

67. Serbia(0.826)

56. The former

YugoslavRepublic ofMacedonia (74.1)

63. Seychelles(91.8)

103. United ArabEmirates (71.4)

62. Argentina(13,238)

68. Belarus(0.826)

57. Syrian ArabRepublic (74.1)

64. Jordan (91.1)104. Maldives(71.3)

63. Turkey(12,955)

182. Niger(0.340)

176. Afghanistan(43.6)

151. Mali (26.2) 177. Djibouti(25.5)

181. Congo(298)

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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 percapita 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.

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DisabilityIndicators


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Sullivans Index

Definition

Expectation of life free of disability.

It is computed by subtracting from the lifeexpectancy, the probable duration of beddisability and inability to perform majoractivities or Activities of Daily Living (ADL).

Sullivans index is considered to be one of themost advanced indicators currently available.

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HALE (HealthAdjusted Life Expectancy)

Definition

HALE is the number of years in full health thata newborn can expect to live based on current

rates of ill-health and mortality.

HALE is Life Expectancy atBirth, but includesan adjustment for time spent in poor health.

The indicator, Disability Adjusted LifeExpectancy (DALE), has been changed to HALE.

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DALY (Disability Adjusted Life


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DALY (DisabilityAdjusted LifeYear)

Definition

DALY is the number of productive orhealthy years of life lost due to prematuredeath, morbidity or disability .

It is a measure of the burden of disease in

a defined population and the effectivenessof the interventions.

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DALYs for a disease or health condition is

calculated as the sum of the Years of Life Lost

(YLL) due to premature mortality in thepopulation 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

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Example of Calculation of DALY

The calculation of DALYs of a man who has beendeaf 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

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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.

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Thank You

mmmc - health indicators

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