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Faculty of Medicine
Public Health (31505291) ة العامالصحة Lecture 2
Indicators and determinants of global health
By
Hatim Jaber MD MPH JBCM PhD
5-6-2017
1
Presentation outline 5-6-2017
Time
Indicators and determinants of global health variations
0800 to 0810
Relationship between socio-economic development and disease patterns in different nations
0810 to 0830
What are the social determinants of health
0830 to 0840
What contribution do income education and other factors make to health
0840 to 0900
2
Determinants of health
bull Many factors combine together to affect the health of individuals and communities
bull Whether people are healthy or not is determined by their circumstances and environment
bull To a large extent factors such as where we live the state of our environment genetics our income and education level and our relationships with friends and family all have considerable impacts on health
bull Access and use of health care services often have less of an impact
Determinants of health
bull The social and economic environment
bull The physical environment
bull The personrsquos individual characteristics and behaviors
bull Access to quality health care
Determinants of health
bull Poverty Income and social status - higher income and social status are linked to better health The greater the gap between the richest and poorest people the greater the differences in health
bull Social support networks ndash greater support from families friends and communities is linked to better health
bull Education ndash low education levels are linked with poor health more stress and lower self-confidence
bull Gender - Men and women suffer from different types of diseases at different ages
bull Culture customs and traditions and the beliefs of the family and community all affect health
Determinants of health
bull Genetics - inheritance plays a part in determining lifespan healthiness and the likelihood of developing certain illnesses
bull Personal behavior and coping skills ndash balanced eating keeping active smoking drinking and how we deal with lifersquos stresses and challenges all affect health
bull Health services - access and use of services that prevent and treat disease influences health
Determinants of health
bull Physical environment
- Safe water and clean air healthy workplaces safe houses communities and roads all contribute to good health
- Employment and working conditions ndash people in employment are healthier particularly those who have more control over their working conditions
Determinants of Health
Plus many more factors such as bull Political stability wars and conflicts
bull Natural disasters
bull Human and civil rights
bull Population growth and economic development in the country
bull Urbanization
Examples
bull Malnutrition ndash ndash more susceptible to disease and less likely to
recover bull Cooking with wood and coal ndash
ndash lung diseases bull Poor sanitation ndash
ndash more intestinal infections bull Poverty
ndash commercial sex work and STIs HIVAIDS bull Advertising tobacco and alcohol ndash
ndash addiction and related diseases bull Untrained drivers on unsafe roads-
ndash road traffic accidents
Health Indicators
What is Health Indicators Definitions
variable which help to measure changes directly or
indirectly (WHO 1981)
A statistic which facilitate concise and balanced
judgments about certain condition
With the goal of good health in mind think of an
indicator as
ldquohellipa measure that helps quantify the
achievement of a goalrdquo(Mark Friedman) Health Indicators Part I
Health Indicator is
bull ldquohellipa measure that helps quantify the
achievement of a goalrdquo -Mark Friedman
Power of indicators is comparisons bull Health indicators are essential for comparing health status - over time (trends) - geographic areas - groups of people and the focus on the most essential domains of health
Health Indicators Part I
A good indicator depends on
bull Availability of high quality data
bull Importance in measuring health status
bull Is well understood at the global level and various comparability options are possible
Health Indicators Part I
Health indicators are important because bull They are essential for monitoring and reporting data for decision making about population health bullTo inform policy makers to formulate evidence based policies and to promote accountability among governmental and non-governmental agencies bullThey are critical for setting priorities assessing the health status at baseline planning allocating resources and monitoring progress towards better health status goals bull Needed for assessing the health problems and trends to create awareness engage all the stakeholders in collaborative action and design interventions
Health Indicators Part I
Important Health Indicators for measurement of Health Status
bull Cause of death
ndash Obtained from death certification but limited because of incomplete coverage
bull Life expectancy at birth
ndash The average number of years a new-borns baby could expect to live if current trends in mortality were to continue for the rest of the new-borns life
bull Maternal mortality rate
ndash The number of women who die as a result of childbirth and pregnancy related complications per 100000 live births in a given year
Infant mortality rate rsaquo The number of deaths in infants under 1 year per 1000
live births for a given year
Neonatal mortality rate rsaquo The number of deaths among infants under 28 days in a
given year per 1000 live births in that year
Under five child mortality rate rsaquo The probability that a new-born will die before reaching
the age of five years expressed as a number per 1000 live births
Important Health Indicators for measurement of Health Status
Types of Health Indicators
Count Number Measure without a denominator
Rate Numerator is part of denominator Frequency of
occurrence of an event during specific time usually
expressed per 1000 population
Ratio Numerator is not included in denominator (sex
ratio)
Index Aggregation of measurement of specific
indicators
Health Indicators Part I
Indicators of Health
Global health indicators highlighting the health inequality
Global health indicators are improving
overall in the worldhellip
But not in all places not for all social
groups and not at the same speed
Health inequality
bullThere is a difference between the health status of one population compared to another population or difference between population subgroups
How to measure health inequality
bullMost measurement of health inequality involves the use of indicators to measure health
Health indicators within the Monitoring Evaluation and Review framework
Source Adapted from Monitoring evaluation and review of national health strategies a country-led platform for information and accountability Geneva World Health Organization 2011
INPUTS AND PROCESSES
OUTPUTS OUTCOMES IMPACT
bull Health financing
bull Health workforce
bull Infrastructure bull Information bull Governance
bull Service access and readiness
bull Service quality and safety
bull Coverage of interventions
bull Risk factors and behaviours
bull Health status bull Financial risk
protection bull Responsiveness
Indicators of Health - classification
bull Mortality indicators
bull Morbidity indicators
bull Disability indicators
bull Nutritional status indicators
bull Health care delivery indicators
bull Health care Utilization indicators
bull Indicators of social and mental health
bull Environmental indicators
bull Socio-economic indicators
bull Health policy indicators
bull Other indicators
Mortality Indicators
a Crude death rate
bull It is defined as the number of deaths per 1000 population
per year in a given community
bull Reducing the number of deaths in the population is an obvious goal of medicine and health care and success or failure to do so is a measure of a nations commitment to better health
Crude death rate = _Number of deaths (all causes)___ 1000
Estimated midyear population
Mortality Indicators
bull Age-specific death rate = ____number of deaths (25-44)_____ 1000
estimated midyear population (25-44)
bull Cause-specific death rate = __Number of deaths (specific cause)__ 100000
Estimated midyear population
Mortality Indicators
b Life expectancy
bull ldquoThe average number of years that will be lived by those born alive into a population if the current age-specific mortality rates persistldquo
bull Life expectancy is a good indicator of socio-economic development in general
bull A minimum life expectancy at birth of 60 years is the goal of Health for All by 2000AD
Mortality Indicators
c Infant Mortality rate bull It is the ratio of deaths under 1 year of age in a given year
to the total number of live births in the same year usually expressed as a rate per 1000 live births
bull It is one of the most universally accepted indicators of health status not only of infants but also of whole population and of the socioeconomic conditions under which they live
bull The global strategy of Health for All has suggested an infant mortality rate of not more than 50 per 1000 live births by 2000 AD
Mortality Indicators
d Child Mortality Rate
bull It is defined as the number of deaths at ages 1-4 years in a given year per 1000 children in that age group at the mid-point of the year concerned
e Maternal Mortality Rate
Maternal Mortality rate
bullMaternal deaths death of a woman 1048633 while pregnant or 1048633 within 42 days of termination of pregnancy 1048633 Irrespective of the duration or site of the pregnancy 1048633 From any cause related to or aggravated by the pregnancy or its management 1048633 Not from accidental causes bullNumber of women who die as a result of complications of pregnancy or childbearing in a given year per 1000 live births in that year bullRepresents both the obstetric risk
Morbidity Indicators
bull Mortality indicators do not reveal the burden of ill health in a community
bull The following morbidity rates are used for assessing ill health in the community
ndash Incidence and Prevalence
ndash Attendance rates at out-patient departments health centers etc
ndash Admission Readmission and Discharge rates
ndash Duration of stay in hospital and
Morbidity Indicators
bull Incidence rate = No of new cases of a disease _in a certain time period___ population at risk in same time period No of new and old cases of a disease
bull Prevalence rate = _________in a certain time period________ population at risk in same time period No of new cases in a narrowly defined
bull Attack rate = ______population during a specific time period______ population at risk in same time period
Disability Rates
bull Disability rates related to illness and injury
bull Used to supplement mortality and morbidity indicators
bull Examples
1 number of days of restricted activity
2 work-loss days (or school-loss days)
Nutritional Status Indicators
bull Anthropometric measurements of preschool children ndash eg weight height mid- arm circumference
bull Heights (and sometimes weights) of children at school entry
bull Prevalence of low birth weight (less than 25 kg)
Health Care Delivery Indicators
bull The frequently used indicators of health care delivery ndash Doctor-population ratio ndash Doctor-nurse ratio ndash Population-bed ratio ndash Population per health center ndash Population per traditional birth attendant
bull These indicators reflect the equity of distribution of
health resources in different parts of the country and of the provision of health care
Utilization rates
bull The extent of use of health services
bull Is expressed as the proportion of people in need of a service who actually receive it in given period usually a year
bull Health care utilization is also affected by factors such as availability and accessibility of health services and the attitude of an individual towards his health and the health care system
Utilization rates
bull Examples of utilization rates
bull proportion of infants who are fully immunized against the 6 EPI diseases
bull proportion of pregnant women who receive antenatal care or have their deliveries supervised by a trained birth attendant
bull bed-occupancy rate (ie average daily in-patient censusaverage number of beds)
bull bed turn-over ration (ie dischargesaverage beds)
Socio-economic Indicators bull These indicators do not directly measure health
But they are of great importance in the interpretation of the indicators of health care ndash rate of population increase ndash per capita GNP ndash level of unemployment ndash dependency ratio ndash literacy rates ndash family size ndash housing the number of persons per room ndash per capita calorie availability
Health Policy Indicators
bull Proportion of GNP spent on health services
bull Proportion of GNP spent on health-related activities (including water supply and sanitation housing and nutrition community development)
bull Proportion of total health resources devoted to primary health care
Who compiles health indicators
bullReports are compiled at every local level - Health departments foundations helliphellip
bullNational ndashgovernmentprivate partnerships
bull International ndash WHO
Data Sources for Common Indicators
bull National Vital Statistics System (Birth Mortality)
bull Census data
bull Surveys (Behavioral Risk Factor Survey--Adults and Youth
National Health Interview Survey National Health and
Nutrition Examination Survey National Survey of Childrens
Health National Immunization Survey)
bull Disease Surveillance Systems
bull Health services administrative data
Health Indicators Part I
Indicators are like a waterhellip Too little of it you die of thirst Too much you drown in it
By Building Health information system able to
generate a list of Essential indicators covering the basic information needs
Keep it straight forward and simple
Global population health and well-being are both determinants and consequences
of major demographic changes
1 Migration within and across countries
2 Women in the paid workforce
3 Decreases in fertility and increase in life expectancy in many countries
So whatrsquos the world going to look like in the next 20-40 yearshellipby 2025 or 2050
Increasingly urban
Increasingly old
Increasingly diverse with migration
Increasing women in workforce
Global trends in longevity
Global Declines in Fertility
Doomsday scenarios
bull Rising inequality
bull Fragile families and communities
bull New urban areas that canrsquot catch up quickly
bull Environmental consequences
bull Social exclusion and ldquodis- integrationrdquo
bull Increased conflict
Presentation outline 5-6-2017
Time
Indicators and determinants of global health variations
0800 to 0810
Relationship between socio-economic development and disease patterns in different nations
0810 to 0830
What are the social determinants of health
0830 to 0840
What contribution do income education and other factors make to health
0840 to 0900
2
Determinants of health
bull Many factors combine together to affect the health of individuals and communities
bull Whether people are healthy or not is determined by their circumstances and environment
bull To a large extent factors such as where we live the state of our environment genetics our income and education level and our relationships with friends and family all have considerable impacts on health
bull Access and use of health care services often have less of an impact
Determinants of health
bull The social and economic environment
bull The physical environment
bull The personrsquos individual characteristics and behaviors
bull Access to quality health care
Determinants of health
bull Poverty Income and social status - higher income and social status are linked to better health The greater the gap between the richest and poorest people the greater the differences in health
bull Social support networks ndash greater support from families friends and communities is linked to better health
bull Education ndash low education levels are linked with poor health more stress and lower self-confidence
bull Gender - Men and women suffer from different types of diseases at different ages
bull Culture customs and traditions and the beliefs of the family and community all affect health
Determinants of health
bull Genetics - inheritance plays a part in determining lifespan healthiness and the likelihood of developing certain illnesses
bull Personal behavior and coping skills ndash balanced eating keeping active smoking drinking and how we deal with lifersquos stresses and challenges all affect health
bull Health services - access and use of services that prevent and treat disease influences health
Determinants of health
bull Physical environment
- Safe water and clean air healthy workplaces safe houses communities and roads all contribute to good health
- Employment and working conditions ndash people in employment are healthier particularly those who have more control over their working conditions
Determinants of Health
Plus many more factors such as bull Political stability wars and conflicts
bull Natural disasters
bull Human and civil rights
bull Population growth and economic development in the country
bull Urbanization
Examples
bull Malnutrition ndash ndash more susceptible to disease and less likely to
recover bull Cooking with wood and coal ndash
ndash lung diseases bull Poor sanitation ndash
ndash more intestinal infections bull Poverty
ndash commercial sex work and STIs HIVAIDS bull Advertising tobacco and alcohol ndash
ndash addiction and related diseases bull Untrained drivers on unsafe roads-
ndash road traffic accidents
Health Indicators
What is Health Indicators Definitions
variable which help to measure changes directly or
indirectly (WHO 1981)
A statistic which facilitate concise and balanced
judgments about certain condition
With the goal of good health in mind think of an
indicator as
ldquohellipa measure that helps quantify the
achievement of a goalrdquo(Mark Friedman) Health Indicators Part I
Health Indicator is
bull ldquohellipa measure that helps quantify the
achievement of a goalrdquo -Mark Friedman
Power of indicators is comparisons bull Health indicators are essential for comparing health status - over time (trends) - geographic areas - groups of people and the focus on the most essential domains of health
Health Indicators Part I
A good indicator depends on
bull Availability of high quality data
bull Importance in measuring health status
bull Is well understood at the global level and various comparability options are possible
Health Indicators Part I
Health indicators are important because bull They are essential for monitoring and reporting data for decision making about population health bullTo inform policy makers to formulate evidence based policies and to promote accountability among governmental and non-governmental agencies bullThey are critical for setting priorities assessing the health status at baseline planning allocating resources and monitoring progress towards better health status goals bull Needed for assessing the health problems and trends to create awareness engage all the stakeholders in collaborative action and design interventions
Health Indicators Part I
Important Health Indicators for measurement of Health Status
bull Cause of death
ndash Obtained from death certification but limited because of incomplete coverage
bull Life expectancy at birth
ndash The average number of years a new-borns baby could expect to live if current trends in mortality were to continue for the rest of the new-borns life
bull Maternal mortality rate
ndash The number of women who die as a result of childbirth and pregnancy related complications per 100000 live births in a given year
Infant mortality rate rsaquo The number of deaths in infants under 1 year per 1000
live births for a given year
Neonatal mortality rate rsaquo The number of deaths among infants under 28 days in a
given year per 1000 live births in that year
Under five child mortality rate rsaquo The probability that a new-born will die before reaching
the age of five years expressed as a number per 1000 live births
Important Health Indicators for measurement of Health Status
Types of Health Indicators
Count Number Measure without a denominator
Rate Numerator is part of denominator Frequency of
occurrence of an event during specific time usually
expressed per 1000 population
Ratio Numerator is not included in denominator (sex
ratio)
Index Aggregation of measurement of specific
indicators
Health Indicators Part I
Indicators of Health
Global health indicators highlighting the health inequality
Global health indicators are improving
overall in the worldhellip
But not in all places not for all social
groups and not at the same speed
Health inequality
bullThere is a difference between the health status of one population compared to another population or difference between population subgroups
How to measure health inequality
bullMost measurement of health inequality involves the use of indicators to measure health
Health indicators within the Monitoring Evaluation and Review framework
Source Adapted from Monitoring evaluation and review of national health strategies a country-led platform for information and accountability Geneva World Health Organization 2011
INPUTS AND PROCESSES
OUTPUTS OUTCOMES IMPACT
bull Health financing
bull Health workforce
bull Infrastructure bull Information bull Governance
bull Service access and readiness
bull Service quality and safety
bull Coverage of interventions
bull Risk factors and behaviours
bull Health status bull Financial risk
protection bull Responsiveness
Indicators of Health - classification
bull Mortality indicators
bull Morbidity indicators
bull Disability indicators
bull Nutritional status indicators
bull Health care delivery indicators
bull Health care Utilization indicators
bull Indicators of social and mental health
bull Environmental indicators
bull Socio-economic indicators
bull Health policy indicators
bull Other indicators
Mortality Indicators
a Crude death rate
bull It is defined as the number of deaths per 1000 population
per year in a given community
bull Reducing the number of deaths in the population is an obvious goal of medicine and health care and success or failure to do so is a measure of a nations commitment to better health
Crude death rate = _Number of deaths (all causes)___ 1000
Estimated midyear population
Mortality Indicators
bull Age-specific death rate = ____number of deaths (25-44)_____ 1000
estimated midyear population (25-44)
bull Cause-specific death rate = __Number of deaths (specific cause)__ 100000
Estimated midyear population
Mortality Indicators
b Life expectancy
bull ldquoThe average number of years that will be lived by those born alive into a population if the current age-specific mortality rates persistldquo
bull Life expectancy is a good indicator of socio-economic development in general
bull A minimum life expectancy at birth of 60 years is the goal of Health for All by 2000AD
Mortality Indicators
c Infant Mortality rate bull It is the ratio of deaths under 1 year of age in a given year
to the total number of live births in the same year usually expressed as a rate per 1000 live births
bull It is one of the most universally accepted indicators of health status not only of infants but also of whole population and of the socioeconomic conditions under which they live
bull The global strategy of Health for All has suggested an infant mortality rate of not more than 50 per 1000 live births by 2000 AD
Mortality Indicators
d Child Mortality Rate
bull It is defined as the number of deaths at ages 1-4 years in a given year per 1000 children in that age group at the mid-point of the year concerned
e Maternal Mortality Rate
Maternal Mortality rate
bullMaternal deaths death of a woman 1048633 while pregnant or 1048633 within 42 days of termination of pregnancy 1048633 Irrespective of the duration or site of the pregnancy 1048633 From any cause related to or aggravated by the pregnancy or its management 1048633 Not from accidental causes bullNumber of women who die as a result of complications of pregnancy or childbearing in a given year per 1000 live births in that year bullRepresents both the obstetric risk
Morbidity Indicators
bull Mortality indicators do not reveal the burden of ill health in a community
bull The following morbidity rates are used for assessing ill health in the community
ndash Incidence and Prevalence
ndash Attendance rates at out-patient departments health centers etc
ndash Admission Readmission and Discharge rates
ndash Duration of stay in hospital and
Morbidity Indicators
bull Incidence rate = No of new cases of a disease _in a certain time period___ population at risk in same time period No of new and old cases of a disease
bull Prevalence rate = _________in a certain time period________ population at risk in same time period No of new cases in a narrowly defined
bull Attack rate = ______population during a specific time period______ population at risk in same time period
Disability Rates
bull Disability rates related to illness and injury
bull Used to supplement mortality and morbidity indicators
bull Examples
1 number of days of restricted activity
2 work-loss days (or school-loss days)
Nutritional Status Indicators
bull Anthropometric measurements of preschool children ndash eg weight height mid- arm circumference
bull Heights (and sometimes weights) of children at school entry
bull Prevalence of low birth weight (less than 25 kg)
Health Care Delivery Indicators
bull The frequently used indicators of health care delivery ndash Doctor-population ratio ndash Doctor-nurse ratio ndash Population-bed ratio ndash Population per health center ndash Population per traditional birth attendant
bull These indicators reflect the equity of distribution of
health resources in different parts of the country and of the provision of health care
Utilization rates
bull The extent of use of health services
bull Is expressed as the proportion of people in need of a service who actually receive it in given period usually a year
bull Health care utilization is also affected by factors such as availability and accessibility of health services and the attitude of an individual towards his health and the health care system
Utilization rates
bull Examples of utilization rates
bull proportion of infants who are fully immunized against the 6 EPI diseases
bull proportion of pregnant women who receive antenatal care or have their deliveries supervised by a trained birth attendant
bull bed-occupancy rate (ie average daily in-patient censusaverage number of beds)
bull bed turn-over ration (ie dischargesaverage beds)
Socio-economic Indicators bull These indicators do not directly measure health
But they are of great importance in the interpretation of the indicators of health care ndash rate of population increase ndash per capita GNP ndash level of unemployment ndash dependency ratio ndash literacy rates ndash family size ndash housing the number of persons per room ndash per capita calorie availability
Health Policy Indicators
bull Proportion of GNP spent on health services
bull Proportion of GNP spent on health-related activities (including water supply and sanitation housing and nutrition community development)
bull Proportion of total health resources devoted to primary health care
Who compiles health indicators
bullReports are compiled at every local level - Health departments foundations helliphellip
bullNational ndashgovernmentprivate partnerships
bull International ndash WHO
Data Sources for Common Indicators
bull National Vital Statistics System (Birth Mortality)
bull Census data
bull Surveys (Behavioral Risk Factor Survey--Adults and Youth
National Health Interview Survey National Health and
Nutrition Examination Survey National Survey of Childrens
Health National Immunization Survey)
bull Disease Surveillance Systems
bull Health services administrative data
Health Indicators Part I
Indicators are like a waterhellip Too little of it you die of thirst Too much you drown in it
By Building Health information system able to
generate a list of Essential indicators covering the basic information needs
Keep it straight forward and simple
Global population health and well-being are both determinants and consequences
of major demographic changes
1 Migration within and across countries
2 Women in the paid workforce
3 Decreases in fertility and increase in life expectancy in many countries
So whatrsquos the world going to look like in the next 20-40 yearshellipby 2025 or 2050
Increasingly urban
Increasingly old
Increasingly diverse with migration
Increasing women in workforce
Global trends in longevity
Global Declines in Fertility
Doomsday scenarios
bull Rising inequality
bull Fragile families and communities
bull New urban areas that canrsquot catch up quickly
bull Environmental consequences
bull Social exclusion and ldquodis- integrationrdquo
bull Increased conflict
Determinants of health
bull Many factors combine together to affect the health of individuals and communities
bull Whether people are healthy or not is determined by their circumstances and environment
bull To a large extent factors such as where we live the state of our environment genetics our income and education level and our relationships with friends and family all have considerable impacts on health
bull Access and use of health care services often have less of an impact
Determinants of health
bull The social and economic environment
bull The physical environment
bull The personrsquos individual characteristics and behaviors
bull Access to quality health care
Determinants of health
bull Poverty Income and social status - higher income and social status are linked to better health The greater the gap between the richest and poorest people the greater the differences in health
bull Social support networks ndash greater support from families friends and communities is linked to better health
bull Education ndash low education levels are linked with poor health more stress and lower self-confidence
bull Gender - Men and women suffer from different types of diseases at different ages
bull Culture customs and traditions and the beliefs of the family and community all affect health
Determinants of health
bull Genetics - inheritance plays a part in determining lifespan healthiness and the likelihood of developing certain illnesses
bull Personal behavior and coping skills ndash balanced eating keeping active smoking drinking and how we deal with lifersquos stresses and challenges all affect health
bull Health services - access and use of services that prevent and treat disease influences health
Determinants of health
bull Physical environment
- Safe water and clean air healthy workplaces safe houses communities and roads all contribute to good health
- Employment and working conditions ndash people in employment are healthier particularly those who have more control over their working conditions
Determinants of Health
Plus many more factors such as bull Political stability wars and conflicts
bull Natural disasters
bull Human and civil rights
bull Population growth and economic development in the country
bull Urbanization
Examples
bull Malnutrition ndash ndash more susceptible to disease and less likely to
recover bull Cooking with wood and coal ndash
ndash lung diseases bull Poor sanitation ndash
ndash more intestinal infections bull Poverty
ndash commercial sex work and STIs HIVAIDS bull Advertising tobacco and alcohol ndash
ndash addiction and related diseases bull Untrained drivers on unsafe roads-
ndash road traffic accidents
Health Indicators
What is Health Indicators Definitions
variable which help to measure changes directly or
indirectly (WHO 1981)
A statistic which facilitate concise and balanced
judgments about certain condition
With the goal of good health in mind think of an
indicator as
ldquohellipa measure that helps quantify the
achievement of a goalrdquo(Mark Friedman) Health Indicators Part I
Health Indicator is
bull ldquohellipa measure that helps quantify the
achievement of a goalrdquo -Mark Friedman
Power of indicators is comparisons bull Health indicators are essential for comparing health status - over time (trends) - geographic areas - groups of people and the focus on the most essential domains of health
Health Indicators Part I
A good indicator depends on
bull Availability of high quality data
bull Importance in measuring health status
bull Is well understood at the global level and various comparability options are possible
Health Indicators Part I
Health indicators are important because bull They are essential for monitoring and reporting data for decision making about population health bullTo inform policy makers to formulate evidence based policies and to promote accountability among governmental and non-governmental agencies bullThey are critical for setting priorities assessing the health status at baseline planning allocating resources and monitoring progress towards better health status goals bull Needed for assessing the health problems and trends to create awareness engage all the stakeholders in collaborative action and design interventions
Health Indicators Part I
Important Health Indicators for measurement of Health Status
bull Cause of death
ndash Obtained from death certification but limited because of incomplete coverage
bull Life expectancy at birth
ndash The average number of years a new-borns baby could expect to live if current trends in mortality were to continue for the rest of the new-borns life
bull Maternal mortality rate
ndash The number of women who die as a result of childbirth and pregnancy related complications per 100000 live births in a given year
Infant mortality rate rsaquo The number of deaths in infants under 1 year per 1000
live births for a given year
Neonatal mortality rate rsaquo The number of deaths among infants under 28 days in a
given year per 1000 live births in that year
Under five child mortality rate rsaquo The probability that a new-born will die before reaching
the age of five years expressed as a number per 1000 live births
Important Health Indicators for measurement of Health Status
Types of Health Indicators
Count Number Measure without a denominator
Rate Numerator is part of denominator Frequency of
occurrence of an event during specific time usually
expressed per 1000 population
Ratio Numerator is not included in denominator (sex
ratio)
Index Aggregation of measurement of specific
indicators
Health Indicators Part I
Indicators of Health
Global health indicators highlighting the health inequality
Global health indicators are improving
overall in the worldhellip
But not in all places not for all social
groups and not at the same speed
Health inequality
bullThere is a difference between the health status of one population compared to another population or difference between population subgroups
How to measure health inequality
bullMost measurement of health inequality involves the use of indicators to measure health
Health indicators within the Monitoring Evaluation and Review framework
Source Adapted from Monitoring evaluation and review of national health strategies a country-led platform for information and accountability Geneva World Health Organization 2011
INPUTS AND PROCESSES
OUTPUTS OUTCOMES IMPACT
bull Health financing
bull Health workforce
bull Infrastructure bull Information bull Governance
bull Service access and readiness
bull Service quality and safety
bull Coverage of interventions
bull Risk factors and behaviours
bull Health status bull Financial risk
protection bull Responsiveness
Indicators of Health - classification
bull Mortality indicators
bull Morbidity indicators
bull Disability indicators
bull Nutritional status indicators
bull Health care delivery indicators
bull Health care Utilization indicators
bull Indicators of social and mental health
bull Environmental indicators
bull Socio-economic indicators
bull Health policy indicators
bull Other indicators
Mortality Indicators
a Crude death rate
bull It is defined as the number of deaths per 1000 population
per year in a given community
bull Reducing the number of deaths in the population is an obvious goal of medicine and health care and success or failure to do so is a measure of a nations commitment to better health
Crude death rate = _Number of deaths (all causes)___ 1000
Estimated midyear population
Mortality Indicators
bull Age-specific death rate = ____number of deaths (25-44)_____ 1000
estimated midyear population (25-44)
bull Cause-specific death rate = __Number of deaths (specific cause)__ 100000
Estimated midyear population
Mortality Indicators
b Life expectancy
bull ldquoThe average number of years that will be lived by those born alive into a population if the current age-specific mortality rates persistldquo
bull Life expectancy is a good indicator of socio-economic development in general
bull A minimum life expectancy at birth of 60 years is the goal of Health for All by 2000AD
Mortality Indicators
c Infant Mortality rate bull It is the ratio of deaths under 1 year of age in a given year
to the total number of live births in the same year usually expressed as a rate per 1000 live births
bull It is one of the most universally accepted indicators of health status not only of infants but also of whole population and of the socioeconomic conditions under which they live
bull The global strategy of Health for All has suggested an infant mortality rate of not more than 50 per 1000 live births by 2000 AD
Mortality Indicators
d Child Mortality Rate
bull It is defined as the number of deaths at ages 1-4 years in a given year per 1000 children in that age group at the mid-point of the year concerned
e Maternal Mortality Rate
Maternal Mortality rate
bullMaternal deaths death of a woman 1048633 while pregnant or 1048633 within 42 days of termination of pregnancy 1048633 Irrespective of the duration or site of the pregnancy 1048633 From any cause related to or aggravated by the pregnancy or its management 1048633 Not from accidental causes bullNumber of women who die as a result of complications of pregnancy or childbearing in a given year per 1000 live births in that year bullRepresents both the obstetric risk
Morbidity Indicators
bull Mortality indicators do not reveal the burden of ill health in a community
bull The following morbidity rates are used for assessing ill health in the community
ndash Incidence and Prevalence
ndash Attendance rates at out-patient departments health centers etc
ndash Admission Readmission and Discharge rates
ndash Duration of stay in hospital and
Morbidity Indicators
bull Incidence rate = No of new cases of a disease _in a certain time period___ population at risk in same time period No of new and old cases of a disease
bull Prevalence rate = _________in a certain time period________ population at risk in same time period No of new cases in a narrowly defined
bull Attack rate = ______population during a specific time period______ population at risk in same time period
Disability Rates
bull Disability rates related to illness and injury
bull Used to supplement mortality and morbidity indicators
bull Examples
1 number of days of restricted activity
2 work-loss days (or school-loss days)
Nutritional Status Indicators
bull Anthropometric measurements of preschool children ndash eg weight height mid- arm circumference
bull Heights (and sometimes weights) of children at school entry
bull Prevalence of low birth weight (less than 25 kg)
Health Care Delivery Indicators
bull The frequently used indicators of health care delivery ndash Doctor-population ratio ndash Doctor-nurse ratio ndash Population-bed ratio ndash Population per health center ndash Population per traditional birth attendant
bull These indicators reflect the equity of distribution of
health resources in different parts of the country and of the provision of health care
Utilization rates
bull The extent of use of health services
bull Is expressed as the proportion of people in need of a service who actually receive it in given period usually a year
bull Health care utilization is also affected by factors such as availability and accessibility of health services and the attitude of an individual towards his health and the health care system
Utilization rates
bull Examples of utilization rates
bull proportion of infants who are fully immunized against the 6 EPI diseases
bull proportion of pregnant women who receive antenatal care or have their deliveries supervised by a trained birth attendant
bull bed-occupancy rate (ie average daily in-patient censusaverage number of beds)
bull bed turn-over ration (ie dischargesaverage beds)
Socio-economic Indicators bull These indicators do not directly measure health
But they are of great importance in the interpretation of the indicators of health care ndash rate of population increase ndash per capita GNP ndash level of unemployment ndash dependency ratio ndash literacy rates ndash family size ndash housing the number of persons per room ndash per capita calorie availability
Health Policy Indicators
bull Proportion of GNP spent on health services
bull Proportion of GNP spent on health-related activities (including water supply and sanitation housing and nutrition community development)
bull Proportion of total health resources devoted to primary health care
Who compiles health indicators
bullReports are compiled at every local level - Health departments foundations helliphellip
bullNational ndashgovernmentprivate partnerships
bull International ndash WHO
Data Sources for Common Indicators
bull National Vital Statistics System (Birth Mortality)
bull Census data
bull Surveys (Behavioral Risk Factor Survey--Adults and Youth
National Health Interview Survey National Health and
Nutrition Examination Survey National Survey of Childrens
Health National Immunization Survey)
bull Disease Surveillance Systems
bull Health services administrative data
Health Indicators Part I
Indicators are like a waterhellip Too little of it you die of thirst Too much you drown in it
By Building Health information system able to
generate a list of Essential indicators covering the basic information needs
Keep it straight forward and simple
Global population health and well-being are both determinants and consequences
of major demographic changes
1 Migration within and across countries
2 Women in the paid workforce
3 Decreases in fertility and increase in life expectancy in many countries
So whatrsquos the world going to look like in the next 20-40 yearshellipby 2025 or 2050
Increasingly urban
Increasingly old
Increasingly diverse with migration
Increasing women in workforce
Global trends in longevity
Global Declines in Fertility
Doomsday scenarios
bull Rising inequality
bull Fragile families and communities
bull New urban areas that canrsquot catch up quickly
bull Environmental consequences
bull Social exclusion and ldquodis- integrationrdquo
bull Increased conflict
Determinants of health
bull The social and economic environment
bull The physical environment
bull The personrsquos individual characteristics and behaviors
bull Access to quality health care
Determinants of health
bull Poverty Income and social status - higher income and social status are linked to better health The greater the gap between the richest and poorest people the greater the differences in health
bull Social support networks ndash greater support from families friends and communities is linked to better health
bull Education ndash low education levels are linked with poor health more stress and lower self-confidence
bull Gender - Men and women suffer from different types of diseases at different ages
bull Culture customs and traditions and the beliefs of the family and community all affect health
Determinants of health
bull Genetics - inheritance plays a part in determining lifespan healthiness and the likelihood of developing certain illnesses
bull Personal behavior and coping skills ndash balanced eating keeping active smoking drinking and how we deal with lifersquos stresses and challenges all affect health
bull Health services - access and use of services that prevent and treat disease influences health
Determinants of health
bull Physical environment
- Safe water and clean air healthy workplaces safe houses communities and roads all contribute to good health
- Employment and working conditions ndash people in employment are healthier particularly those who have more control over their working conditions
Determinants of Health
Plus many more factors such as bull Political stability wars and conflicts
bull Natural disasters
bull Human and civil rights
bull Population growth and economic development in the country
bull Urbanization
Examples
bull Malnutrition ndash ndash more susceptible to disease and less likely to
recover bull Cooking with wood and coal ndash
ndash lung diseases bull Poor sanitation ndash
ndash more intestinal infections bull Poverty
ndash commercial sex work and STIs HIVAIDS bull Advertising tobacco and alcohol ndash
ndash addiction and related diseases bull Untrained drivers on unsafe roads-
ndash road traffic accidents
Health Indicators
What is Health Indicators Definitions
variable which help to measure changes directly or
indirectly (WHO 1981)
A statistic which facilitate concise and balanced
judgments about certain condition
With the goal of good health in mind think of an
indicator as
ldquohellipa measure that helps quantify the
achievement of a goalrdquo(Mark Friedman) Health Indicators Part I
Health Indicator is
bull ldquohellipa measure that helps quantify the
achievement of a goalrdquo -Mark Friedman
Power of indicators is comparisons bull Health indicators are essential for comparing health status - over time (trends) - geographic areas - groups of people and the focus on the most essential domains of health
Health Indicators Part I
A good indicator depends on
bull Availability of high quality data
bull Importance in measuring health status
bull Is well understood at the global level and various comparability options are possible
Health Indicators Part I
Health indicators are important because bull They are essential for monitoring and reporting data for decision making about population health bullTo inform policy makers to formulate evidence based policies and to promote accountability among governmental and non-governmental agencies bullThey are critical for setting priorities assessing the health status at baseline planning allocating resources and monitoring progress towards better health status goals bull Needed for assessing the health problems and trends to create awareness engage all the stakeholders in collaborative action and design interventions
Health Indicators Part I
Important Health Indicators for measurement of Health Status
bull Cause of death
ndash Obtained from death certification but limited because of incomplete coverage
bull Life expectancy at birth
ndash The average number of years a new-borns baby could expect to live if current trends in mortality were to continue for the rest of the new-borns life
bull Maternal mortality rate
ndash The number of women who die as a result of childbirth and pregnancy related complications per 100000 live births in a given year
Infant mortality rate rsaquo The number of deaths in infants under 1 year per 1000
live births for a given year
Neonatal mortality rate rsaquo The number of deaths among infants under 28 days in a
given year per 1000 live births in that year
Under five child mortality rate rsaquo The probability that a new-born will die before reaching
the age of five years expressed as a number per 1000 live births
Important Health Indicators for measurement of Health Status
Types of Health Indicators
Count Number Measure without a denominator
Rate Numerator is part of denominator Frequency of
occurrence of an event during specific time usually
expressed per 1000 population
Ratio Numerator is not included in denominator (sex
ratio)
Index Aggregation of measurement of specific
indicators
Health Indicators Part I
Indicators of Health
Global health indicators highlighting the health inequality
Global health indicators are improving
overall in the worldhellip
But not in all places not for all social
groups and not at the same speed
Health inequality
bullThere is a difference between the health status of one population compared to another population or difference between population subgroups
How to measure health inequality
bullMost measurement of health inequality involves the use of indicators to measure health
Health indicators within the Monitoring Evaluation and Review framework
Source Adapted from Monitoring evaluation and review of national health strategies a country-led platform for information and accountability Geneva World Health Organization 2011
INPUTS AND PROCESSES
OUTPUTS OUTCOMES IMPACT
bull Health financing
bull Health workforce
bull Infrastructure bull Information bull Governance
bull Service access and readiness
bull Service quality and safety
bull Coverage of interventions
bull Risk factors and behaviours
bull Health status bull Financial risk
protection bull Responsiveness
Indicators of Health - classification
bull Mortality indicators
bull Morbidity indicators
bull Disability indicators
bull Nutritional status indicators
bull Health care delivery indicators
bull Health care Utilization indicators
bull Indicators of social and mental health
bull Environmental indicators
bull Socio-economic indicators
bull Health policy indicators
bull Other indicators
Mortality Indicators
a Crude death rate
bull It is defined as the number of deaths per 1000 population
per year in a given community
bull Reducing the number of deaths in the population is an obvious goal of medicine and health care and success or failure to do so is a measure of a nations commitment to better health
Crude death rate = _Number of deaths (all causes)___ 1000
Estimated midyear population
Mortality Indicators
bull Age-specific death rate = ____number of deaths (25-44)_____ 1000
estimated midyear population (25-44)
bull Cause-specific death rate = __Number of deaths (specific cause)__ 100000
Estimated midyear population
Mortality Indicators
b Life expectancy
bull ldquoThe average number of years that will be lived by those born alive into a population if the current age-specific mortality rates persistldquo
bull Life expectancy is a good indicator of socio-economic development in general
bull A minimum life expectancy at birth of 60 years is the goal of Health for All by 2000AD
Mortality Indicators
c Infant Mortality rate bull It is the ratio of deaths under 1 year of age in a given year
to the total number of live births in the same year usually expressed as a rate per 1000 live births
bull It is one of the most universally accepted indicators of health status not only of infants but also of whole population and of the socioeconomic conditions under which they live
bull The global strategy of Health for All has suggested an infant mortality rate of not more than 50 per 1000 live births by 2000 AD
Mortality Indicators
d Child Mortality Rate
bull It is defined as the number of deaths at ages 1-4 years in a given year per 1000 children in that age group at the mid-point of the year concerned
e Maternal Mortality Rate
Maternal Mortality rate
bullMaternal deaths death of a woman 1048633 while pregnant or 1048633 within 42 days of termination of pregnancy 1048633 Irrespective of the duration or site of the pregnancy 1048633 From any cause related to or aggravated by the pregnancy or its management 1048633 Not from accidental causes bullNumber of women who die as a result of complications of pregnancy or childbearing in a given year per 1000 live births in that year bullRepresents both the obstetric risk
Morbidity Indicators
bull Mortality indicators do not reveal the burden of ill health in a community
bull The following morbidity rates are used for assessing ill health in the community
ndash Incidence and Prevalence
ndash Attendance rates at out-patient departments health centers etc
ndash Admission Readmission and Discharge rates
ndash Duration of stay in hospital and
Morbidity Indicators
bull Incidence rate = No of new cases of a disease _in a certain time period___ population at risk in same time period No of new and old cases of a disease
bull Prevalence rate = _________in a certain time period________ population at risk in same time period No of new cases in a narrowly defined
bull Attack rate = ______population during a specific time period______ population at risk in same time period
Disability Rates
bull Disability rates related to illness and injury
bull Used to supplement mortality and morbidity indicators
bull Examples
1 number of days of restricted activity
2 work-loss days (or school-loss days)
Nutritional Status Indicators
bull Anthropometric measurements of preschool children ndash eg weight height mid- arm circumference
bull Heights (and sometimes weights) of children at school entry
bull Prevalence of low birth weight (less than 25 kg)
Health Care Delivery Indicators
bull The frequently used indicators of health care delivery ndash Doctor-population ratio ndash Doctor-nurse ratio ndash Population-bed ratio ndash Population per health center ndash Population per traditional birth attendant
bull These indicators reflect the equity of distribution of
health resources in different parts of the country and of the provision of health care
Utilization rates
bull The extent of use of health services
bull Is expressed as the proportion of people in need of a service who actually receive it in given period usually a year
bull Health care utilization is also affected by factors such as availability and accessibility of health services and the attitude of an individual towards his health and the health care system
Utilization rates
bull Examples of utilization rates
bull proportion of infants who are fully immunized against the 6 EPI diseases
bull proportion of pregnant women who receive antenatal care or have their deliveries supervised by a trained birth attendant
bull bed-occupancy rate (ie average daily in-patient censusaverage number of beds)
bull bed turn-over ration (ie dischargesaverage beds)
Socio-economic Indicators bull These indicators do not directly measure health
But they are of great importance in the interpretation of the indicators of health care ndash rate of population increase ndash per capita GNP ndash level of unemployment ndash dependency ratio ndash literacy rates ndash family size ndash housing the number of persons per room ndash per capita calorie availability
Health Policy Indicators
bull Proportion of GNP spent on health services
bull Proportion of GNP spent on health-related activities (including water supply and sanitation housing and nutrition community development)
bull Proportion of total health resources devoted to primary health care
Who compiles health indicators
bullReports are compiled at every local level - Health departments foundations helliphellip
bullNational ndashgovernmentprivate partnerships
bull International ndash WHO
Data Sources for Common Indicators
bull National Vital Statistics System (Birth Mortality)
bull Census data
bull Surveys (Behavioral Risk Factor Survey--Adults and Youth
National Health Interview Survey National Health and
Nutrition Examination Survey National Survey of Childrens
Health National Immunization Survey)
bull Disease Surveillance Systems
bull Health services administrative data
Health Indicators Part I
Indicators are like a waterhellip Too little of it you die of thirst Too much you drown in it
By Building Health information system able to
generate a list of Essential indicators covering the basic information needs
Keep it straight forward and simple
Global population health and well-being are both determinants and consequences
of major demographic changes
1 Migration within and across countries
2 Women in the paid workforce
3 Decreases in fertility and increase in life expectancy in many countries
So whatrsquos the world going to look like in the next 20-40 yearshellipby 2025 or 2050
Increasingly urban
Increasingly old
Increasingly diverse with migration
Increasing women in workforce
Global trends in longevity
Global Declines in Fertility
Doomsday scenarios
bull Rising inequality
bull Fragile families and communities
bull New urban areas that canrsquot catch up quickly
bull Environmental consequences
bull Social exclusion and ldquodis- integrationrdquo
bull Increased conflict
Determinants of health
bull Poverty Income and social status - higher income and social status are linked to better health The greater the gap between the richest and poorest people the greater the differences in health
bull Social support networks ndash greater support from families friends and communities is linked to better health
bull Education ndash low education levels are linked with poor health more stress and lower self-confidence
bull Gender - Men and women suffer from different types of diseases at different ages
bull Culture customs and traditions and the beliefs of the family and community all affect health
Determinants of health
bull Genetics - inheritance plays a part in determining lifespan healthiness and the likelihood of developing certain illnesses
bull Personal behavior and coping skills ndash balanced eating keeping active smoking drinking and how we deal with lifersquos stresses and challenges all affect health
bull Health services - access and use of services that prevent and treat disease influences health
Determinants of health
bull Physical environment
- Safe water and clean air healthy workplaces safe houses communities and roads all contribute to good health
- Employment and working conditions ndash people in employment are healthier particularly those who have more control over their working conditions
Determinants of Health
Plus many more factors such as bull Political stability wars and conflicts
bull Natural disasters
bull Human and civil rights
bull Population growth and economic development in the country
bull Urbanization
Examples
bull Malnutrition ndash ndash more susceptible to disease and less likely to
recover bull Cooking with wood and coal ndash
ndash lung diseases bull Poor sanitation ndash
ndash more intestinal infections bull Poverty
ndash commercial sex work and STIs HIVAIDS bull Advertising tobacco and alcohol ndash
ndash addiction and related diseases bull Untrained drivers on unsafe roads-
ndash road traffic accidents
Health Indicators
What is Health Indicators Definitions
variable which help to measure changes directly or
indirectly (WHO 1981)
A statistic which facilitate concise and balanced
judgments about certain condition
With the goal of good health in mind think of an
indicator as
ldquohellipa measure that helps quantify the
achievement of a goalrdquo(Mark Friedman) Health Indicators Part I
Health Indicator is
bull ldquohellipa measure that helps quantify the
achievement of a goalrdquo -Mark Friedman
Power of indicators is comparisons bull Health indicators are essential for comparing health status - over time (trends) - geographic areas - groups of people and the focus on the most essential domains of health
Health Indicators Part I
A good indicator depends on
bull Availability of high quality data
bull Importance in measuring health status
bull Is well understood at the global level and various comparability options are possible
Health Indicators Part I
Health indicators are important because bull They are essential for monitoring and reporting data for decision making about population health bullTo inform policy makers to formulate evidence based policies and to promote accountability among governmental and non-governmental agencies bullThey are critical for setting priorities assessing the health status at baseline planning allocating resources and monitoring progress towards better health status goals bull Needed for assessing the health problems and trends to create awareness engage all the stakeholders in collaborative action and design interventions
Health Indicators Part I
Important Health Indicators for measurement of Health Status
bull Cause of death
ndash Obtained from death certification but limited because of incomplete coverage
bull Life expectancy at birth
ndash The average number of years a new-borns baby could expect to live if current trends in mortality were to continue for the rest of the new-borns life
bull Maternal mortality rate
ndash The number of women who die as a result of childbirth and pregnancy related complications per 100000 live births in a given year
Infant mortality rate rsaquo The number of deaths in infants under 1 year per 1000
live births for a given year
Neonatal mortality rate rsaquo The number of deaths among infants under 28 days in a
given year per 1000 live births in that year
Under five child mortality rate rsaquo The probability that a new-born will die before reaching
the age of five years expressed as a number per 1000 live births
Important Health Indicators for measurement of Health Status
Types of Health Indicators
Count Number Measure without a denominator
Rate Numerator is part of denominator Frequency of
occurrence of an event during specific time usually
expressed per 1000 population
Ratio Numerator is not included in denominator (sex
ratio)
Index Aggregation of measurement of specific
indicators
Health Indicators Part I
Indicators of Health
Global health indicators highlighting the health inequality
Global health indicators are improving
overall in the worldhellip
But not in all places not for all social
groups and not at the same speed
Health inequality
bullThere is a difference between the health status of one population compared to another population or difference between population subgroups
How to measure health inequality
bullMost measurement of health inequality involves the use of indicators to measure health
Health indicators within the Monitoring Evaluation and Review framework
Source Adapted from Monitoring evaluation and review of national health strategies a country-led platform for information and accountability Geneva World Health Organization 2011
INPUTS AND PROCESSES
OUTPUTS OUTCOMES IMPACT
bull Health financing
bull Health workforce
bull Infrastructure bull Information bull Governance
bull Service access and readiness
bull Service quality and safety
bull Coverage of interventions
bull Risk factors and behaviours
bull Health status bull Financial risk
protection bull Responsiveness
Indicators of Health - classification
bull Mortality indicators
bull Morbidity indicators
bull Disability indicators
bull Nutritional status indicators
bull Health care delivery indicators
bull Health care Utilization indicators
bull Indicators of social and mental health
bull Environmental indicators
bull Socio-economic indicators
bull Health policy indicators
bull Other indicators
Mortality Indicators
a Crude death rate
bull It is defined as the number of deaths per 1000 population
per year in a given community
bull Reducing the number of deaths in the population is an obvious goal of medicine and health care and success or failure to do so is a measure of a nations commitment to better health
Crude death rate = _Number of deaths (all causes)___ 1000
Estimated midyear population
Mortality Indicators
bull Age-specific death rate = ____number of deaths (25-44)_____ 1000
estimated midyear population (25-44)
bull Cause-specific death rate = __Number of deaths (specific cause)__ 100000
Estimated midyear population
Mortality Indicators
b Life expectancy
bull ldquoThe average number of years that will be lived by those born alive into a population if the current age-specific mortality rates persistldquo
bull Life expectancy is a good indicator of socio-economic development in general
bull A minimum life expectancy at birth of 60 years is the goal of Health for All by 2000AD
Mortality Indicators
c Infant Mortality rate bull It is the ratio of deaths under 1 year of age in a given year
to the total number of live births in the same year usually expressed as a rate per 1000 live births
bull It is one of the most universally accepted indicators of health status not only of infants but also of whole population and of the socioeconomic conditions under which they live
bull The global strategy of Health for All has suggested an infant mortality rate of not more than 50 per 1000 live births by 2000 AD
Mortality Indicators
d Child Mortality Rate
bull It is defined as the number of deaths at ages 1-4 years in a given year per 1000 children in that age group at the mid-point of the year concerned
e Maternal Mortality Rate
Maternal Mortality rate
bullMaternal deaths death of a woman 1048633 while pregnant or 1048633 within 42 days of termination of pregnancy 1048633 Irrespective of the duration or site of the pregnancy 1048633 From any cause related to or aggravated by the pregnancy or its management 1048633 Not from accidental causes bullNumber of women who die as a result of complications of pregnancy or childbearing in a given year per 1000 live births in that year bullRepresents both the obstetric risk
Morbidity Indicators
bull Mortality indicators do not reveal the burden of ill health in a community
bull The following morbidity rates are used for assessing ill health in the community
ndash Incidence and Prevalence
ndash Attendance rates at out-patient departments health centers etc
ndash Admission Readmission and Discharge rates
ndash Duration of stay in hospital and
Morbidity Indicators
bull Incidence rate = No of new cases of a disease _in a certain time period___ population at risk in same time period No of new and old cases of a disease
bull Prevalence rate = _________in a certain time period________ population at risk in same time period No of new cases in a narrowly defined
bull Attack rate = ______population during a specific time period______ population at risk in same time period
Disability Rates
bull Disability rates related to illness and injury
bull Used to supplement mortality and morbidity indicators
bull Examples
1 number of days of restricted activity
2 work-loss days (or school-loss days)
Nutritional Status Indicators
bull Anthropometric measurements of preschool children ndash eg weight height mid- arm circumference
bull Heights (and sometimes weights) of children at school entry
bull Prevalence of low birth weight (less than 25 kg)
Health Care Delivery Indicators
bull The frequently used indicators of health care delivery ndash Doctor-population ratio ndash Doctor-nurse ratio ndash Population-bed ratio ndash Population per health center ndash Population per traditional birth attendant
bull These indicators reflect the equity of distribution of
health resources in different parts of the country and of the provision of health care
Utilization rates
bull The extent of use of health services
bull Is expressed as the proportion of people in need of a service who actually receive it in given period usually a year
bull Health care utilization is also affected by factors such as availability and accessibility of health services and the attitude of an individual towards his health and the health care system
Utilization rates
bull Examples of utilization rates
bull proportion of infants who are fully immunized against the 6 EPI diseases
bull proportion of pregnant women who receive antenatal care or have their deliveries supervised by a trained birth attendant
bull bed-occupancy rate (ie average daily in-patient censusaverage number of beds)
bull bed turn-over ration (ie dischargesaverage beds)
Socio-economic Indicators bull These indicators do not directly measure health
But they are of great importance in the interpretation of the indicators of health care ndash rate of population increase ndash per capita GNP ndash level of unemployment ndash dependency ratio ndash literacy rates ndash family size ndash housing the number of persons per room ndash per capita calorie availability
Health Policy Indicators
bull Proportion of GNP spent on health services
bull Proportion of GNP spent on health-related activities (including water supply and sanitation housing and nutrition community development)
bull Proportion of total health resources devoted to primary health care
Who compiles health indicators
bullReports are compiled at every local level - Health departments foundations helliphellip
bullNational ndashgovernmentprivate partnerships
bull International ndash WHO
Data Sources for Common Indicators
bull National Vital Statistics System (Birth Mortality)
bull Census data
bull Surveys (Behavioral Risk Factor Survey--Adults and Youth
National Health Interview Survey National Health and
Nutrition Examination Survey National Survey of Childrens
Health National Immunization Survey)
bull Disease Surveillance Systems
bull Health services administrative data
Health Indicators Part I
Indicators are like a waterhellip Too little of it you die of thirst Too much you drown in it
By Building Health information system able to
generate a list of Essential indicators covering the basic information needs
Keep it straight forward and simple
Global population health and well-being are both determinants and consequences
of major demographic changes
1 Migration within and across countries
2 Women in the paid workforce
3 Decreases in fertility and increase in life expectancy in many countries
So whatrsquos the world going to look like in the next 20-40 yearshellipby 2025 or 2050
Increasingly urban
Increasingly old
Increasingly diverse with migration
Increasing women in workforce
Global trends in longevity
Global Declines in Fertility
Doomsday scenarios
bull Rising inequality
bull Fragile families and communities
bull New urban areas that canrsquot catch up quickly
bull Environmental consequences
bull Social exclusion and ldquodis- integrationrdquo
bull Increased conflict
Determinants of health
bull Genetics - inheritance plays a part in determining lifespan healthiness and the likelihood of developing certain illnesses
bull Personal behavior and coping skills ndash balanced eating keeping active smoking drinking and how we deal with lifersquos stresses and challenges all affect health
bull Health services - access and use of services that prevent and treat disease influences health
Determinants of health
bull Physical environment
- Safe water and clean air healthy workplaces safe houses communities and roads all contribute to good health
- Employment and working conditions ndash people in employment are healthier particularly those who have more control over their working conditions
Determinants of Health
Plus many more factors such as bull Political stability wars and conflicts
bull Natural disasters
bull Human and civil rights
bull Population growth and economic development in the country
bull Urbanization
Examples
bull Malnutrition ndash ndash more susceptible to disease and less likely to
recover bull Cooking with wood and coal ndash
ndash lung diseases bull Poor sanitation ndash
ndash more intestinal infections bull Poverty
ndash commercial sex work and STIs HIVAIDS bull Advertising tobacco and alcohol ndash
ndash addiction and related diseases bull Untrained drivers on unsafe roads-
ndash road traffic accidents
Health Indicators
What is Health Indicators Definitions
variable which help to measure changes directly or
indirectly (WHO 1981)
A statistic which facilitate concise and balanced
judgments about certain condition
With the goal of good health in mind think of an
indicator as
ldquohellipa measure that helps quantify the
achievement of a goalrdquo(Mark Friedman) Health Indicators Part I
Health Indicator is
bull ldquohellipa measure that helps quantify the
achievement of a goalrdquo -Mark Friedman
Power of indicators is comparisons bull Health indicators are essential for comparing health status - over time (trends) - geographic areas - groups of people and the focus on the most essential domains of health
Health Indicators Part I
A good indicator depends on
bull Availability of high quality data
bull Importance in measuring health status
bull Is well understood at the global level and various comparability options are possible
Health Indicators Part I
Health indicators are important because bull They are essential for monitoring and reporting data for decision making about population health bullTo inform policy makers to formulate evidence based policies and to promote accountability among governmental and non-governmental agencies bullThey are critical for setting priorities assessing the health status at baseline planning allocating resources and monitoring progress towards better health status goals bull Needed for assessing the health problems and trends to create awareness engage all the stakeholders in collaborative action and design interventions
Health Indicators Part I
Important Health Indicators for measurement of Health Status
bull Cause of death
ndash Obtained from death certification but limited because of incomplete coverage
bull Life expectancy at birth
ndash The average number of years a new-borns baby could expect to live if current trends in mortality were to continue for the rest of the new-borns life
bull Maternal mortality rate
ndash The number of women who die as a result of childbirth and pregnancy related complications per 100000 live births in a given year
Infant mortality rate rsaquo The number of deaths in infants under 1 year per 1000
live births for a given year
Neonatal mortality rate rsaquo The number of deaths among infants under 28 days in a
given year per 1000 live births in that year
Under five child mortality rate rsaquo The probability that a new-born will die before reaching
the age of five years expressed as a number per 1000 live births
Important Health Indicators for measurement of Health Status
Types of Health Indicators
Count Number Measure without a denominator
Rate Numerator is part of denominator Frequency of
occurrence of an event during specific time usually
expressed per 1000 population
Ratio Numerator is not included in denominator (sex
ratio)
Index Aggregation of measurement of specific
indicators
Health Indicators Part I
Indicators of Health
Global health indicators highlighting the health inequality
Global health indicators are improving
overall in the worldhellip
But not in all places not for all social
groups and not at the same speed
Health inequality
bullThere is a difference between the health status of one population compared to another population or difference between population subgroups
How to measure health inequality
bullMost measurement of health inequality involves the use of indicators to measure health
Health indicators within the Monitoring Evaluation and Review framework
Source Adapted from Monitoring evaluation and review of national health strategies a country-led platform for information and accountability Geneva World Health Organization 2011
INPUTS AND PROCESSES
OUTPUTS OUTCOMES IMPACT
bull Health financing
bull Health workforce
bull Infrastructure bull Information bull Governance
bull Service access and readiness
bull Service quality and safety
bull Coverage of interventions
bull Risk factors and behaviours
bull Health status bull Financial risk
protection bull Responsiveness
Indicators of Health - classification
bull Mortality indicators
bull Morbidity indicators
bull Disability indicators
bull Nutritional status indicators
bull Health care delivery indicators
bull Health care Utilization indicators
bull Indicators of social and mental health
bull Environmental indicators
bull Socio-economic indicators
bull Health policy indicators
bull Other indicators
Mortality Indicators
a Crude death rate
bull It is defined as the number of deaths per 1000 population
per year in a given community
bull Reducing the number of deaths in the population is an obvious goal of medicine and health care and success or failure to do so is a measure of a nations commitment to better health
Crude death rate = _Number of deaths (all causes)___ 1000
Estimated midyear population
Mortality Indicators
bull Age-specific death rate = ____number of deaths (25-44)_____ 1000
estimated midyear population (25-44)
bull Cause-specific death rate = __Number of deaths (specific cause)__ 100000
Estimated midyear population
Mortality Indicators
b Life expectancy
bull ldquoThe average number of years that will be lived by those born alive into a population if the current age-specific mortality rates persistldquo
bull Life expectancy is a good indicator of socio-economic development in general
bull A minimum life expectancy at birth of 60 years is the goal of Health for All by 2000AD
Mortality Indicators
c Infant Mortality rate bull It is the ratio of deaths under 1 year of age in a given year
to the total number of live births in the same year usually expressed as a rate per 1000 live births
bull It is one of the most universally accepted indicators of health status not only of infants but also of whole population and of the socioeconomic conditions under which they live
bull The global strategy of Health for All has suggested an infant mortality rate of not more than 50 per 1000 live births by 2000 AD
Mortality Indicators
d Child Mortality Rate
bull It is defined as the number of deaths at ages 1-4 years in a given year per 1000 children in that age group at the mid-point of the year concerned
e Maternal Mortality Rate
Maternal Mortality rate
bullMaternal deaths death of a woman 1048633 while pregnant or 1048633 within 42 days of termination of pregnancy 1048633 Irrespective of the duration or site of the pregnancy 1048633 From any cause related to or aggravated by the pregnancy or its management 1048633 Not from accidental causes bullNumber of women who die as a result of complications of pregnancy or childbearing in a given year per 1000 live births in that year bullRepresents both the obstetric risk
Morbidity Indicators
bull Mortality indicators do not reveal the burden of ill health in a community
bull The following morbidity rates are used for assessing ill health in the community
ndash Incidence and Prevalence
ndash Attendance rates at out-patient departments health centers etc
ndash Admission Readmission and Discharge rates
ndash Duration of stay in hospital and
Morbidity Indicators
bull Incidence rate = No of new cases of a disease _in a certain time period___ population at risk in same time period No of new and old cases of a disease
bull Prevalence rate = _________in a certain time period________ population at risk in same time period No of new cases in a narrowly defined
bull Attack rate = ______population during a specific time period______ population at risk in same time period
Disability Rates
bull Disability rates related to illness and injury
bull Used to supplement mortality and morbidity indicators
bull Examples
1 number of days of restricted activity
2 work-loss days (or school-loss days)
Nutritional Status Indicators
bull Anthropometric measurements of preschool children ndash eg weight height mid- arm circumference
bull Heights (and sometimes weights) of children at school entry
bull Prevalence of low birth weight (less than 25 kg)
Health Care Delivery Indicators
bull The frequently used indicators of health care delivery ndash Doctor-population ratio ndash Doctor-nurse ratio ndash Population-bed ratio ndash Population per health center ndash Population per traditional birth attendant
bull These indicators reflect the equity of distribution of
health resources in different parts of the country and of the provision of health care
Utilization rates
bull The extent of use of health services
bull Is expressed as the proportion of people in need of a service who actually receive it in given period usually a year
bull Health care utilization is also affected by factors such as availability and accessibility of health services and the attitude of an individual towards his health and the health care system
Utilization rates
bull Examples of utilization rates
bull proportion of infants who are fully immunized against the 6 EPI diseases
bull proportion of pregnant women who receive antenatal care or have their deliveries supervised by a trained birth attendant
bull bed-occupancy rate (ie average daily in-patient censusaverage number of beds)
bull bed turn-over ration (ie dischargesaverage beds)
Socio-economic Indicators bull These indicators do not directly measure health
But they are of great importance in the interpretation of the indicators of health care ndash rate of population increase ndash per capita GNP ndash level of unemployment ndash dependency ratio ndash literacy rates ndash family size ndash housing the number of persons per room ndash per capita calorie availability
Health Policy Indicators
bull Proportion of GNP spent on health services
bull Proportion of GNP spent on health-related activities (including water supply and sanitation housing and nutrition community development)
bull Proportion of total health resources devoted to primary health care
Who compiles health indicators
bullReports are compiled at every local level - Health departments foundations helliphellip
bullNational ndashgovernmentprivate partnerships
bull International ndash WHO
Data Sources for Common Indicators
bull National Vital Statistics System (Birth Mortality)
bull Census data
bull Surveys (Behavioral Risk Factor Survey--Adults and Youth
National Health Interview Survey National Health and
Nutrition Examination Survey National Survey of Childrens
Health National Immunization Survey)
bull Disease Surveillance Systems
bull Health services administrative data
Health Indicators Part I
Indicators are like a waterhellip Too little of it you die of thirst Too much you drown in it
By Building Health information system able to
generate a list of Essential indicators covering the basic information needs
Keep it straight forward and simple
Global population health and well-being are both determinants and consequences
of major demographic changes
1 Migration within and across countries
2 Women in the paid workforce
3 Decreases in fertility and increase in life expectancy in many countries
So whatrsquos the world going to look like in the next 20-40 yearshellipby 2025 or 2050
Increasingly urban
Increasingly old
Increasingly diverse with migration
Increasing women in workforce
Global trends in longevity
Global Declines in Fertility
Doomsday scenarios
bull Rising inequality
bull Fragile families and communities
bull New urban areas that canrsquot catch up quickly
bull Environmental consequences
bull Social exclusion and ldquodis- integrationrdquo
bull Increased conflict
Determinants of health
bull Physical environment
- Safe water and clean air healthy workplaces safe houses communities and roads all contribute to good health
- Employment and working conditions ndash people in employment are healthier particularly those who have more control over their working conditions
Determinants of Health
Plus many more factors such as bull Political stability wars and conflicts
bull Natural disasters
bull Human and civil rights
bull Population growth and economic development in the country
bull Urbanization
Examples
bull Malnutrition ndash ndash more susceptible to disease and less likely to
recover bull Cooking with wood and coal ndash
ndash lung diseases bull Poor sanitation ndash
ndash more intestinal infections bull Poverty
ndash commercial sex work and STIs HIVAIDS bull Advertising tobacco and alcohol ndash
ndash addiction and related diseases bull Untrained drivers on unsafe roads-
ndash road traffic accidents
Health Indicators
What is Health Indicators Definitions
variable which help to measure changes directly or
indirectly (WHO 1981)
A statistic which facilitate concise and balanced
judgments about certain condition
With the goal of good health in mind think of an
indicator as
ldquohellipa measure that helps quantify the
achievement of a goalrdquo(Mark Friedman) Health Indicators Part I
Health Indicator is
bull ldquohellipa measure that helps quantify the
achievement of a goalrdquo -Mark Friedman
Power of indicators is comparisons bull Health indicators are essential for comparing health status - over time (trends) - geographic areas - groups of people and the focus on the most essential domains of health
Health Indicators Part I
A good indicator depends on
bull Availability of high quality data
bull Importance in measuring health status
bull Is well understood at the global level and various comparability options are possible
Health Indicators Part I
Health indicators are important because bull They are essential for monitoring and reporting data for decision making about population health bullTo inform policy makers to formulate evidence based policies and to promote accountability among governmental and non-governmental agencies bullThey are critical for setting priorities assessing the health status at baseline planning allocating resources and monitoring progress towards better health status goals bull Needed for assessing the health problems and trends to create awareness engage all the stakeholders in collaborative action and design interventions
Health Indicators Part I
Important Health Indicators for measurement of Health Status
bull Cause of death
ndash Obtained from death certification but limited because of incomplete coverage
bull Life expectancy at birth
ndash The average number of years a new-borns baby could expect to live if current trends in mortality were to continue for the rest of the new-borns life
bull Maternal mortality rate
ndash The number of women who die as a result of childbirth and pregnancy related complications per 100000 live births in a given year
Infant mortality rate rsaquo The number of deaths in infants under 1 year per 1000
live births for a given year
Neonatal mortality rate rsaquo The number of deaths among infants under 28 days in a
given year per 1000 live births in that year
Under five child mortality rate rsaquo The probability that a new-born will die before reaching
the age of five years expressed as a number per 1000 live births
Important Health Indicators for measurement of Health Status
Types of Health Indicators
Count Number Measure without a denominator
Rate Numerator is part of denominator Frequency of
occurrence of an event during specific time usually
expressed per 1000 population
Ratio Numerator is not included in denominator (sex
ratio)
Index Aggregation of measurement of specific
indicators
Health Indicators Part I
Indicators of Health
Global health indicators highlighting the health inequality
Global health indicators are improving
overall in the worldhellip
But not in all places not for all social
groups and not at the same speed
Health inequality
bullThere is a difference between the health status of one population compared to another population or difference between population subgroups
How to measure health inequality
bullMost measurement of health inequality involves the use of indicators to measure health
Health indicators within the Monitoring Evaluation and Review framework
Source Adapted from Monitoring evaluation and review of national health strategies a country-led platform for information and accountability Geneva World Health Organization 2011
INPUTS AND PROCESSES
OUTPUTS OUTCOMES IMPACT
bull Health financing
bull Health workforce
bull Infrastructure bull Information bull Governance
bull Service access and readiness
bull Service quality and safety
bull Coverage of interventions
bull Risk factors and behaviours
bull Health status bull Financial risk
protection bull Responsiveness
Indicators of Health - classification
bull Mortality indicators
bull Morbidity indicators
bull Disability indicators
bull Nutritional status indicators
bull Health care delivery indicators
bull Health care Utilization indicators
bull Indicators of social and mental health
bull Environmental indicators
bull Socio-economic indicators
bull Health policy indicators
bull Other indicators
Mortality Indicators
a Crude death rate
bull It is defined as the number of deaths per 1000 population
per year in a given community
bull Reducing the number of deaths in the population is an obvious goal of medicine and health care and success or failure to do so is a measure of a nations commitment to better health
Crude death rate = _Number of deaths (all causes)___ 1000
Estimated midyear population
Mortality Indicators
bull Age-specific death rate = ____number of deaths (25-44)_____ 1000
estimated midyear population (25-44)
bull Cause-specific death rate = __Number of deaths (specific cause)__ 100000
Estimated midyear population
Mortality Indicators
b Life expectancy
bull ldquoThe average number of years that will be lived by those born alive into a population if the current age-specific mortality rates persistldquo
bull Life expectancy is a good indicator of socio-economic development in general
bull A minimum life expectancy at birth of 60 years is the goal of Health for All by 2000AD
Mortality Indicators
c Infant Mortality rate bull It is the ratio of deaths under 1 year of age in a given year
to the total number of live births in the same year usually expressed as a rate per 1000 live births
bull It is one of the most universally accepted indicators of health status not only of infants but also of whole population and of the socioeconomic conditions under which they live
bull The global strategy of Health for All has suggested an infant mortality rate of not more than 50 per 1000 live births by 2000 AD
Mortality Indicators
d Child Mortality Rate
bull It is defined as the number of deaths at ages 1-4 years in a given year per 1000 children in that age group at the mid-point of the year concerned
e Maternal Mortality Rate
Maternal Mortality rate
bullMaternal deaths death of a woman 1048633 while pregnant or 1048633 within 42 days of termination of pregnancy 1048633 Irrespective of the duration or site of the pregnancy 1048633 From any cause related to or aggravated by the pregnancy or its management 1048633 Not from accidental causes bullNumber of women who die as a result of complications of pregnancy or childbearing in a given year per 1000 live births in that year bullRepresents both the obstetric risk
Morbidity Indicators
bull Mortality indicators do not reveal the burden of ill health in a community
bull The following morbidity rates are used for assessing ill health in the community
ndash Incidence and Prevalence
ndash Attendance rates at out-patient departments health centers etc
ndash Admission Readmission and Discharge rates
ndash Duration of stay in hospital and
Morbidity Indicators
bull Incidence rate = No of new cases of a disease _in a certain time period___ population at risk in same time period No of new and old cases of a disease
bull Prevalence rate = _________in a certain time period________ population at risk in same time period No of new cases in a narrowly defined
bull Attack rate = ______population during a specific time period______ population at risk in same time period
Disability Rates
bull Disability rates related to illness and injury
bull Used to supplement mortality and morbidity indicators
bull Examples
1 number of days of restricted activity
2 work-loss days (or school-loss days)
Nutritional Status Indicators
bull Anthropometric measurements of preschool children ndash eg weight height mid- arm circumference
bull Heights (and sometimes weights) of children at school entry
bull Prevalence of low birth weight (less than 25 kg)
Health Care Delivery Indicators
bull The frequently used indicators of health care delivery ndash Doctor-population ratio ndash Doctor-nurse ratio ndash Population-bed ratio ndash Population per health center ndash Population per traditional birth attendant
bull These indicators reflect the equity of distribution of
health resources in different parts of the country and of the provision of health care
Utilization rates
bull The extent of use of health services
bull Is expressed as the proportion of people in need of a service who actually receive it in given period usually a year
bull Health care utilization is also affected by factors such as availability and accessibility of health services and the attitude of an individual towards his health and the health care system
Utilization rates
bull Examples of utilization rates
bull proportion of infants who are fully immunized against the 6 EPI diseases
bull proportion of pregnant women who receive antenatal care or have their deliveries supervised by a trained birth attendant
bull bed-occupancy rate (ie average daily in-patient censusaverage number of beds)
bull bed turn-over ration (ie dischargesaverage beds)
Socio-economic Indicators bull These indicators do not directly measure health
But they are of great importance in the interpretation of the indicators of health care ndash rate of population increase ndash per capita GNP ndash level of unemployment ndash dependency ratio ndash literacy rates ndash family size ndash housing the number of persons per room ndash per capita calorie availability
Health Policy Indicators
bull Proportion of GNP spent on health services
bull Proportion of GNP spent on health-related activities (including water supply and sanitation housing and nutrition community development)
bull Proportion of total health resources devoted to primary health care
Who compiles health indicators
bullReports are compiled at every local level - Health departments foundations helliphellip
bullNational ndashgovernmentprivate partnerships
bull International ndash WHO
Data Sources for Common Indicators
bull National Vital Statistics System (Birth Mortality)
bull Census data
bull Surveys (Behavioral Risk Factor Survey--Adults and Youth
National Health Interview Survey National Health and
Nutrition Examination Survey National Survey of Childrens
Health National Immunization Survey)
bull Disease Surveillance Systems
bull Health services administrative data
Health Indicators Part I
Indicators are like a waterhellip Too little of it you die of thirst Too much you drown in it
By Building Health information system able to
generate a list of Essential indicators covering the basic information needs
Keep it straight forward and simple
Global population health and well-being are both determinants and consequences
of major demographic changes
1 Migration within and across countries
2 Women in the paid workforce
3 Decreases in fertility and increase in life expectancy in many countries
So whatrsquos the world going to look like in the next 20-40 yearshellipby 2025 or 2050
Increasingly urban
Increasingly old
Increasingly diverse with migration
Increasing women in workforce
Global trends in longevity
Global Declines in Fertility
Doomsday scenarios
bull Rising inequality
bull Fragile families and communities
bull New urban areas that canrsquot catch up quickly
bull Environmental consequences
bull Social exclusion and ldquodis- integrationrdquo
bull Increased conflict
Determinants of Health
Plus many more factors such as bull Political stability wars and conflicts
bull Natural disasters
bull Human and civil rights
bull Population growth and economic development in the country
bull Urbanization
Examples
bull Malnutrition ndash ndash more susceptible to disease and less likely to
recover bull Cooking with wood and coal ndash
ndash lung diseases bull Poor sanitation ndash
ndash more intestinal infections bull Poverty
ndash commercial sex work and STIs HIVAIDS bull Advertising tobacco and alcohol ndash
ndash addiction and related diseases bull Untrained drivers on unsafe roads-
ndash road traffic accidents
Health Indicators
What is Health Indicators Definitions
variable which help to measure changes directly or
indirectly (WHO 1981)
A statistic which facilitate concise and balanced
judgments about certain condition
With the goal of good health in mind think of an
indicator as
ldquohellipa measure that helps quantify the
achievement of a goalrdquo(Mark Friedman) Health Indicators Part I
Health Indicator is
bull ldquohellipa measure that helps quantify the
achievement of a goalrdquo -Mark Friedman
Power of indicators is comparisons bull Health indicators are essential for comparing health status - over time (trends) - geographic areas - groups of people and the focus on the most essential domains of health
Health Indicators Part I
A good indicator depends on
bull Availability of high quality data
bull Importance in measuring health status
bull Is well understood at the global level and various comparability options are possible
Health Indicators Part I
Health indicators are important because bull They are essential for monitoring and reporting data for decision making about population health bullTo inform policy makers to formulate evidence based policies and to promote accountability among governmental and non-governmental agencies bullThey are critical for setting priorities assessing the health status at baseline planning allocating resources and monitoring progress towards better health status goals bull Needed for assessing the health problems and trends to create awareness engage all the stakeholders in collaborative action and design interventions
Health Indicators Part I
Important Health Indicators for measurement of Health Status
bull Cause of death
ndash Obtained from death certification but limited because of incomplete coverage
bull Life expectancy at birth
ndash The average number of years a new-borns baby could expect to live if current trends in mortality were to continue for the rest of the new-borns life
bull Maternal mortality rate
ndash The number of women who die as a result of childbirth and pregnancy related complications per 100000 live births in a given year
Infant mortality rate rsaquo The number of deaths in infants under 1 year per 1000
live births for a given year
Neonatal mortality rate rsaquo The number of deaths among infants under 28 days in a
given year per 1000 live births in that year
Under five child mortality rate rsaquo The probability that a new-born will die before reaching
the age of five years expressed as a number per 1000 live births
Important Health Indicators for measurement of Health Status
Types of Health Indicators
Count Number Measure without a denominator
Rate Numerator is part of denominator Frequency of
occurrence of an event during specific time usually
expressed per 1000 population
Ratio Numerator is not included in denominator (sex
ratio)
Index Aggregation of measurement of specific
indicators
Health Indicators Part I
Indicators of Health
Global health indicators highlighting the health inequality
Global health indicators are improving
overall in the worldhellip
But not in all places not for all social
groups and not at the same speed
Health inequality
bullThere is a difference between the health status of one population compared to another population or difference between population subgroups
How to measure health inequality
bullMost measurement of health inequality involves the use of indicators to measure health
Health indicators within the Monitoring Evaluation and Review framework
Source Adapted from Monitoring evaluation and review of national health strategies a country-led platform for information and accountability Geneva World Health Organization 2011
INPUTS AND PROCESSES
OUTPUTS OUTCOMES IMPACT
bull Health financing
bull Health workforce
bull Infrastructure bull Information bull Governance
bull Service access and readiness
bull Service quality and safety
bull Coverage of interventions
bull Risk factors and behaviours
bull Health status bull Financial risk
protection bull Responsiveness
Indicators of Health - classification
bull Mortality indicators
bull Morbidity indicators
bull Disability indicators
bull Nutritional status indicators
bull Health care delivery indicators
bull Health care Utilization indicators
bull Indicators of social and mental health
bull Environmental indicators
bull Socio-economic indicators
bull Health policy indicators
bull Other indicators
Mortality Indicators
a Crude death rate
bull It is defined as the number of deaths per 1000 population
per year in a given community
bull Reducing the number of deaths in the population is an obvious goal of medicine and health care and success or failure to do so is a measure of a nations commitment to better health
Crude death rate = _Number of deaths (all causes)___ 1000
Estimated midyear population
Mortality Indicators
bull Age-specific death rate = ____number of deaths (25-44)_____ 1000
estimated midyear population (25-44)
bull Cause-specific death rate = __Number of deaths (specific cause)__ 100000
Estimated midyear population
Mortality Indicators
b Life expectancy
bull ldquoThe average number of years that will be lived by those born alive into a population if the current age-specific mortality rates persistldquo
bull Life expectancy is a good indicator of socio-economic development in general
bull A minimum life expectancy at birth of 60 years is the goal of Health for All by 2000AD
Mortality Indicators
c Infant Mortality rate bull It is the ratio of deaths under 1 year of age in a given year
to the total number of live births in the same year usually expressed as a rate per 1000 live births
bull It is one of the most universally accepted indicators of health status not only of infants but also of whole population and of the socioeconomic conditions under which they live
bull The global strategy of Health for All has suggested an infant mortality rate of not more than 50 per 1000 live births by 2000 AD
Mortality Indicators
d Child Mortality Rate
bull It is defined as the number of deaths at ages 1-4 years in a given year per 1000 children in that age group at the mid-point of the year concerned
e Maternal Mortality Rate
Maternal Mortality rate
bullMaternal deaths death of a woman 1048633 while pregnant or 1048633 within 42 days of termination of pregnancy 1048633 Irrespective of the duration or site of the pregnancy 1048633 From any cause related to or aggravated by the pregnancy or its management 1048633 Not from accidental causes bullNumber of women who die as a result of complications of pregnancy or childbearing in a given year per 1000 live births in that year bullRepresents both the obstetric risk
Morbidity Indicators
bull Mortality indicators do not reveal the burden of ill health in a community
bull The following morbidity rates are used for assessing ill health in the community
ndash Incidence and Prevalence
ndash Attendance rates at out-patient departments health centers etc
ndash Admission Readmission and Discharge rates
ndash Duration of stay in hospital and
Morbidity Indicators
bull Incidence rate = No of new cases of a disease _in a certain time period___ population at risk in same time period No of new and old cases of a disease
bull Prevalence rate = _________in a certain time period________ population at risk in same time period No of new cases in a narrowly defined
bull Attack rate = ______population during a specific time period______ population at risk in same time period
Disability Rates
bull Disability rates related to illness and injury
bull Used to supplement mortality and morbidity indicators
bull Examples
1 number of days of restricted activity
2 work-loss days (or school-loss days)
Nutritional Status Indicators
bull Anthropometric measurements of preschool children ndash eg weight height mid- arm circumference
bull Heights (and sometimes weights) of children at school entry
bull Prevalence of low birth weight (less than 25 kg)
Health Care Delivery Indicators
bull The frequently used indicators of health care delivery ndash Doctor-population ratio ndash Doctor-nurse ratio ndash Population-bed ratio ndash Population per health center ndash Population per traditional birth attendant
bull These indicators reflect the equity of distribution of
health resources in different parts of the country and of the provision of health care
Utilization rates
bull The extent of use of health services
bull Is expressed as the proportion of people in need of a service who actually receive it in given period usually a year
bull Health care utilization is also affected by factors such as availability and accessibility of health services and the attitude of an individual towards his health and the health care system
Utilization rates
bull Examples of utilization rates
bull proportion of infants who are fully immunized against the 6 EPI diseases
bull proportion of pregnant women who receive antenatal care or have their deliveries supervised by a trained birth attendant
bull bed-occupancy rate (ie average daily in-patient censusaverage number of beds)
bull bed turn-over ration (ie dischargesaverage beds)
Socio-economic Indicators bull These indicators do not directly measure health
But they are of great importance in the interpretation of the indicators of health care ndash rate of population increase ndash per capita GNP ndash level of unemployment ndash dependency ratio ndash literacy rates ndash family size ndash housing the number of persons per room ndash per capita calorie availability
Health Policy Indicators
bull Proportion of GNP spent on health services
bull Proportion of GNP spent on health-related activities (including water supply and sanitation housing and nutrition community development)
bull Proportion of total health resources devoted to primary health care
Who compiles health indicators
bullReports are compiled at every local level - Health departments foundations helliphellip
bullNational ndashgovernmentprivate partnerships
bull International ndash WHO
Data Sources for Common Indicators
bull National Vital Statistics System (Birth Mortality)
bull Census data
bull Surveys (Behavioral Risk Factor Survey--Adults and Youth
National Health Interview Survey National Health and
Nutrition Examination Survey National Survey of Childrens
Health National Immunization Survey)
bull Disease Surveillance Systems
bull Health services administrative data
Health Indicators Part I
Indicators are like a waterhellip Too little of it you die of thirst Too much you drown in it
By Building Health information system able to
generate a list of Essential indicators covering the basic information needs
Keep it straight forward and simple
Global population health and well-being are both determinants and consequences
of major demographic changes
1 Migration within and across countries
2 Women in the paid workforce
3 Decreases in fertility and increase in life expectancy in many countries
So whatrsquos the world going to look like in the next 20-40 yearshellipby 2025 or 2050
Increasingly urban
Increasingly old
Increasingly diverse with migration
Increasing women in workforce
Global trends in longevity
Global Declines in Fertility
Doomsday scenarios
bull Rising inequality
bull Fragile families and communities
bull New urban areas that canrsquot catch up quickly
bull Environmental consequences
bull Social exclusion and ldquodis- integrationrdquo
bull Increased conflict
Examples
bull Malnutrition ndash ndash more susceptible to disease and less likely to
recover bull Cooking with wood and coal ndash
ndash lung diseases bull Poor sanitation ndash
ndash more intestinal infections bull Poverty
ndash commercial sex work and STIs HIVAIDS bull Advertising tobacco and alcohol ndash
ndash addiction and related diseases bull Untrained drivers on unsafe roads-
ndash road traffic accidents
Health Indicators
What is Health Indicators Definitions
variable which help to measure changes directly or
indirectly (WHO 1981)
A statistic which facilitate concise and balanced
judgments about certain condition
With the goal of good health in mind think of an
indicator as
ldquohellipa measure that helps quantify the
achievement of a goalrdquo(Mark Friedman) Health Indicators Part I
Health Indicator is
bull ldquohellipa measure that helps quantify the
achievement of a goalrdquo -Mark Friedman
Power of indicators is comparisons bull Health indicators are essential for comparing health status - over time (trends) - geographic areas - groups of people and the focus on the most essential domains of health
Health Indicators Part I
A good indicator depends on
bull Availability of high quality data
bull Importance in measuring health status
bull Is well understood at the global level and various comparability options are possible
Health Indicators Part I
Health indicators are important because bull They are essential for monitoring and reporting data for decision making about population health bullTo inform policy makers to formulate evidence based policies and to promote accountability among governmental and non-governmental agencies bullThey are critical for setting priorities assessing the health status at baseline planning allocating resources and monitoring progress towards better health status goals bull Needed for assessing the health problems and trends to create awareness engage all the stakeholders in collaborative action and design interventions
Health Indicators Part I
Important Health Indicators for measurement of Health Status
bull Cause of death
ndash Obtained from death certification but limited because of incomplete coverage
bull Life expectancy at birth
ndash The average number of years a new-borns baby could expect to live if current trends in mortality were to continue for the rest of the new-borns life
bull Maternal mortality rate
ndash The number of women who die as a result of childbirth and pregnancy related complications per 100000 live births in a given year
Infant mortality rate rsaquo The number of deaths in infants under 1 year per 1000
live births for a given year
Neonatal mortality rate rsaquo The number of deaths among infants under 28 days in a
given year per 1000 live births in that year
Under five child mortality rate rsaquo The probability that a new-born will die before reaching
the age of five years expressed as a number per 1000 live births
Important Health Indicators for measurement of Health Status
Types of Health Indicators
Count Number Measure without a denominator
Rate Numerator is part of denominator Frequency of
occurrence of an event during specific time usually
expressed per 1000 population
Ratio Numerator is not included in denominator (sex
ratio)
Index Aggregation of measurement of specific
indicators
Health Indicators Part I
Indicators of Health
Global health indicators highlighting the health inequality
Global health indicators are improving
overall in the worldhellip
But not in all places not for all social
groups and not at the same speed
Health inequality
bullThere is a difference between the health status of one population compared to another population or difference between population subgroups
How to measure health inequality
bullMost measurement of health inequality involves the use of indicators to measure health
Health indicators within the Monitoring Evaluation and Review framework
Source Adapted from Monitoring evaluation and review of national health strategies a country-led platform for information and accountability Geneva World Health Organization 2011
INPUTS AND PROCESSES
OUTPUTS OUTCOMES IMPACT
bull Health financing
bull Health workforce
bull Infrastructure bull Information bull Governance
bull Service access and readiness
bull Service quality and safety
bull Coverage of interventions
bull Risk factors and behaviours
bull Health status bull Financial risk
protection bull Responsiveness
Indicators of Health - classification
bull Mortality indicators
bull Morbidity indicators
bull Disability indicators
bull Nutritional status indicators
bull Health care delivery indicators
bull Health care Utilization indicators
bull Indicators of social and mental health
bull Environmental indicators
bull Socio-economic indicators
bull Health policy indicators
bull Other indicators
Mortality Indicators
a Crude death rate
bull It is defined as the number of deaths per 1000 population
per year in a given community
bull Reducing the number of deaths in the population is an obvious goal of medicine and health care and success or failure to do so is a measure of a nations commitment to better health
Crude death rate = _Number of deaths (all causes)___ 1000
Estimated midyear population
Mortality Indicators
bull Age-specific death rate = ____number of deaths (25-44)_____ 1000
estimated midyear population (25-44)
bull Cause-specific death rate = __Number of deaths (specific cause)__ 100000
Estimated midyear population
Mortality Indicators
b Life expectancy
bull ldquoThe average number of years that will be lived by those born alive into a population if the current age-specific mortality rates persistldquo
bull Life expectancy is a good indicator of socio-economic development in general
bull A minimum life expectancy at birth of 60 years is the goal of Health for All by 2000AD
Mortality Indicators
c Infant Mortality rate bull It is the ratio of deaths under 1 year of age in a given year
to the total number of live births in the same year usually expressed as a rate per 1000 live births
bull It is one of the most universally accepted indicators of health status not only of infants but also of whole population and of the socioeconomic conditions under which they live
bull The global strategy of Health for All has suggested an infant mortality rate of not more than 50 per 1000 live births by 2000 AD
Mortality Indicators
d Child Mortality Rate
bull It is defined as the number of deaths at ages 1-4 years in a given year per 1000 children in that age group at the mid-point of the year concerned
e Maternal Mortality Rate
Maternal Mortality rate
bullMaternal deaths death of a woman 1048633 while pregnant or 1048633 within 42 days of termination of pregnancy 1048633 Irrespective of the duration or site of the pregnancy 1048633 From any cause related to or aggravated by the pregnancy or its management 1048633 Not from accidental causes bullNumber of women who die as a result of complications of pregnancy or childbearing in a given year per 1000 live births in that year bullRepresents both the obstetric risk
Morbidity Indicators
bull Mortality indicators do not reveal the burden of ill health in a community
bull The following morbidity rates are used for assessing ill health in the community
ndash Incidence and Prevalence
ndash Attendance rates at out-patient departments health centers etc
ndash Admission Readmission and Discharge rates
ndash Duration of stay in hospital and
Morbidity Indicators
bull Incidence rate = No of new cases of a disease _in a certain time period___ population at risk in same time period No of new and old cases of a disease
bull Prevalence rate = _________in a certain time period________ population at risk in same time period No of new cases in a narrowly defined
bull Attack rate = ______population during a specific time period______ population at risk in same time period
Disability Rates
bull Disability rates related to illness and injury
bull Used to supplement mortality and morbidity indicators
bull Examples
1 number of days of restricted activity
2 work-loss days (or school-loss days)
Nutritional Status Indicators
bull Anthropometric measurements of preschool children ndash eg weight height mid- arm circumference
bull Heights (and sometimes weights) of children at school entry
bull Prevalence of low birth weight (less than 25 kg)
Health Care Delivery Indicators
bull The frequently used indicators of health care delivery ndash Doctor-population ratio ndash Doctor-nurse ratio ndash Population-bed ratio ndash Population per health center ndash Population per traditional birth attendant
bull These indicators reflect the equity of distribution of
health resources in different parts of the country and of the provision of health care
Utilization rates
bull The extent of use of health services
bull Is expressed as the proportion of people in need of a service who actually receive it in given period usually a year
bull Health care utilization is also affected by factors such as availability and accessibility of health services and the attitude of an individual towards his health and the health care system
Utilization rates
bull Examples of utilization rates
bull proportion of infants who are fully immunized against the 6 EPI diseases
bull proportion of pregnant women who receive antenatal care or have their deliveries supervised by a trained birth attendant
bull bed-occupancy rate (ie average daily in-patient censusaverage number of beds)
bull bed turn-over ration (ie dischargesaverage beds)
Socio-economic Indicators bull These indicators do not directly measure health
But they are of great importance in the interpretation of the indicators of health care ndash rate of population increase ndash per capita GNP ndash level of unemployment ndash dependency ratio ndash literacy rates ndash family size ndash housing the number of persons per room ndash per capita calorie availability
Health Policy Indicators
bull Proportion of GNP spent on health services
bull Proportion of GNP spent on health-related activities (including water supply and sanitation housing and nutrition community development)
bull Proportion of total health resources devoted to primary health care
Who compiles health indicators
bullReports are compiled at every local level - Health departments foundations helliphellip
bullNational ndashgovernmentprivate partnerships
bull International ndash WHO
Data Sources for Common Indicators
bull National Vital Statistics System (Birth Mortality)
bull Census data
bull Surveys (Behavioral Risk Factor Survey--Adults and Youth
National Health Interview Survey National Health and
Nutrition Examination Survey National Survey of Childrens
Health National Immunization Survey)
bull Disease Surveillance Systems
bull Health services administrative data
Health Indicators Part I
Indicators are like a waterhellip Too little of it you die of thirst Too much you drown in it
By Building Health information system able to
generate a list of Essential indicators covering the basic information needs
Keep it straight forward and simple
Global population health and well-being are both determinants and consequences
of major demographic changes
1 Migration within and across countries
2 Women in the paid workforce
3 Decreases in fertility and increase in life expectancy in many countries
So whatrsquos the world going to look like in the next 20-40 yearshellipby 2025 or 2050
Increasingly urban
Increasingly old
Increasingly diverse with migration
Increasing women in workforce
Global trends in longevity
Global Declines in Fertility
Doomsday scenarios
bull Rising inequality
bull Fragile families and communities
bull New urban areas that canrsquot catch up quickly
bull Environmental consequences
bull Social exclusion and ldquodis- integrationrdquo
bull Increased conflict
Health Indicators
What is Health Indicators Definitions
variable which help to measure changes directly or
indirectly (WHO 1981)
A statistic which facilitate concise and balanced
judgments about certain condition
With the goal of good health in mind think of an
indicator as
ldquohellipa measure that helps quantify the
achievement of a goalrdquo(Mark Friedman) Health Indicators Part I
Health Indicator is
bull ldquohellipa measure that helps quantify the
achievement of a goalrdquo -Mark Friedman
Power of indicators is comparisons bull Health indicators are essential for comparing health status - over time (trends) - geographic areas - groups of people and the focus on the most essential domains of health
Health Indicators Part I
A good indicator depends on
bull Availability of high quality data
bull Importance in measuring health status
bull Is well understood at the global level and various comparability options are possible
Health Indicators Part I
Health indicators are important because bull They are essential for monitoring and reporting data for decision making about population health bullTo inform policy makers to formulate evidence based policies and to promote accountability among governmental and non-governmental agencies bullThey are critical for setting priorities assessing the health status at baseline planning allocating resources and monitoring progress towards better health status goals bull Needed for assessing the health problems and trends to create awareness engage all the stakeholders in collaborative action and design interventions
Health Indicators Part I
Important Health Indicators for measurement of Health Status
bull Cause of death
ndash Obtained from death certification but limited because of incomplete coverage
bull Life expectancy at birth
ndash The average number of years a new-borns baby could expect to live if current trends in mortality were to continue for the rest of the new-borns life
bull Maternal mortality rate
ndash The number of women who die as a result of childbirth and pregnancy related complications per 100000 live births in a given year
Infant mortality rate rsaquo The number of deaths in infants under 1 year per 1000
live births for a given year
Neonatal mortality rate rsaquo The number of deaths among infants under 28 days in a
given year per 1000 live births in that year
Under five child mortality rate rsaquo The probability that a new-born will die before reaching
the age of five years expressed as a number per 1000 live births
Important Health Indicators for measurement of Health Status
Types of Health Indicators
Count Number Measure without a denominator
Rate Numerator is part of denominator Frequency of
occurrence of an event during specific time usually
expressed per 1000 population
Ratio Numerator is not included in denominator (sex
ratio)
Index Aggregation of measurement of specific
indicators
Health Indicators Part I
Indicators of Health
Global health indicators highlighting the health inequality
Global health indicators are improving
overall in the worldhellip
But not in all places not for all social
groups and not at the same speed
Health inequality
bullThere is a difference between the health status of one population compared to another population or difference between population subgroups
How to measure health inequality
bullMost measurement of health inequality involves the use of indicators to measure health
Health indicators within the Monitoring Evaluation and Review framework
Source Adapted from Monitoring evaluation and review of national health strategies a country-led platform for information and accountability Geneva World Health Organization 2011
INPUTS AND PROCESSES
OUTPUTS OUTCOMES IMPACT
bull Health financing
bull Health workforce
bull Infrastructure bull Information bull Governance
bull Service access and readiness
bull Service quality and safety
bull Coverage of interventions
bull Risk factors and behaviours
bull Health status bull Financial risk
protection bull Responsiveness
Indicators of Health - classification
bull Mortality indicators
bull Morbidity indicators
bull Disability indicators
bull Nutritional status indicators
bull Health care delivery indicators
bull Health care Utilization indicators
bull Indicators of social and mental health
bull Environmental indicators
bull Socio-economic indicators
bull Health policy indicators
bull Other indicators
Mortality Indicators
a Crude death rate
bull It is defined as the number of deaths per 1000 population
per year in a given community
bull Reducing the number of deaths in the population is an obvious goal of medicine and health care and success or failure to do so is a measure of a nations commitment to better health
Crude death rate = _Number of deaths (all causes)___ 1000
Estimated midyear population
Mortality Indicators
bull Age-specific death rate = ____number of deaths (25-44)_____ 1000
estimated midyear population (25-44)
bull Cause-specific death rate = __Number of deaths (specific cause)__ 100000
Estimated midyear population
Mortality Indicators
b Life expectancy
bull ldquoThe average number of years that will be lived by those born alive into a population if the current age-specific mortality rates persistldquo
bull Life expectancy is a good indicator of socio-economic development in general
bull A minimum life expectancy at birth of 60 years is the goal of Health for All by 2000AD
Mortality Indicators
c Infant Mortality rate bull It is the ratio of deaths under 1 year of age in a given year
to the total number of live births in the same year usually expressed as a rate per 1000 live births
bull It is one of the most universally accepted indicators of health status not only of infants but also of whole population and of the socioeconomic conditions under which they live
bull The global strategy of Health for All has suggested an infant mortality rate of not more than 50 per 1000 live births by 2000 AD
Mortality Indicators
d Child Mortality Rate
bull It is defined as the number of deaths at ages 1-4 years in a given year per 1000 children in that age group at the mid-point of the year concerned
e Maternal Mortality Rate
Maternal Mortality rate
bullMaternal deaths death of a woman 1048633 while pregnant or 1048633 within 42 days of termination of pregnancy 1048633 Irrespective of the duration or site of the pregnancy 1048633 From any cause related to or aggravated by the pregnancy or its management 1048633 Not from accidental causes bullNumber of women who die as a result of complications of pregnancy or childbearing in a given year per 1000 live births in that year bullRepresents both the obstetric risk
Morbidity Indicators
bull Mortality indicators do not reveal the burden of ill health in a community
bull The following morbidity rates are used for assessing ill health in the community
ndash Incidence and Prevalence
ndash Attendance rates at out-patient departments health centers etc
ndash Admission Readmission and Discharge rates
ndash Duration of stay in hospital and
Morbidity Indicators
bull Incidence rate = No of new cases of a disease _in a certain time period___ population at risk in same time period No of new and old cases of a disease
bull Prevalence rate = _________in a certain time period________ population at risk in same time period No of new cases in a narrowly defined
bull Attack rate = ______population during a specific time period______ population at risk in same time period
Disability Rates
bull Disability rates related to illness and injury
bull Used to supplement mortality and morbidity indicators
bull Examples
1 number of days of restricted activity
2 work-loss days (or school-loss days)
Nutritional Status Indicators
bull Anthropometric measurements of preschool children ndash eg weight height mid- arm circumference
bull Heights (and sometimes weights) of children at school entry
bull Prevalence of low birth weight (less than 25 kg)
Health Care Delivery Indicators
bull The frequently used indicators of health care delivery ndash Doctor-population ratio ndash Doctor-nurse ratio ndash Population-bed ratio ndash Population per health center ndash Population per traditional birth attendant
bull These indicators reflect the equity of distribution of
health resources in different parts of the country and of the provision of health care
Utilization rates
bull The extent of use of health services
bull Is expressed as the proportion of people in need of a service who actually receive it in given period usually a year
bull Health care utilization is also affected by factors such as availability and accessibility of health services and the attitude of an individual towards his health and the health care system
Utilization rates
bull Examples of utilization rates
bull proportion of infants who are fully immunized against the 6 EPI diseases
bull proportion of pregnant women who receive antenatal care or have their deliveries supervised by a trained birth attendant
bull bed-occupancy rate (ie average daily in-patient censusaverage number of beds)
bull bed turn-over ration (ie dischargesaverage beds)
Socio-economic Indicators bull These indicators do not directly measure health
But they are of great importance in the interpretation of the indicators of health care ndash rate of population increase ndash per capita GNP ndash level of unemployment ndash dependency ratio ndash literacy rates ndash family size ndash housing the number of persons per room ndash per capita calorie availability
Health Policy Indicators
bull Proportion of GNP spent on health services
bull Proportion of GNP spent on health-related activities (including water supply and sanitation housing and nutrition community development)
bull Proportion of total health resources devoted to primary health care
Who compiles health indicators
bullReports are compiled at every local level - Health departments foundations helliphellip
bullNational ndashgovernmentprivate partnerships
bull International ndash WHO
Data Sources for Common Indicators
bull National Vital Statistics System (Birth Mortality)
bull Census data
bull Surveys (Behavioral Risk Factor Survey--Adults and Youth
National Health Interview Survey National Health and
Nutrition Examination Survey National Survey of Childrens
Health National Immunization Survey)
bull Disease Surveillance Systems
bull Health services administrative data
Health Indicators Part I
Indicators are like a waterhellip Too little of it you die of thirst Too much you drown in it
By Building Health information system able to
generate a list of Essential indicators covering the basic information needs
Keep it straight forward and simple
Global population health and well-being are both determinants and consequences
of major demographic changes
1 Migration within and across countries
2 Women in the paid workforce
3 Decreases in fertility and increase in life expectancy in many countries
So whatrsquos the world going to look like in the next 20-40 yearshellipby 2025 or 2050
Increasingly urban
Increasingly old
Increasingly diverse with migration
Increasing women in workforce
Global trends in longevity
Global Declines in Fertility
Doomsday scenarios
bull Rising inequality
bull Fragile families and communities
bull New urban areas that canrsquot catch up quickly
bull Environmental consequences
bull Social exclusion and ldquodis- integrationrdquo
bull Increased conflict
What is Health Indicators Definitions
variable which help to measure changes directly or
indirectly (WHO 1981)
A statistic which facilitate concise and balanced
judgments about certain condition
With the goal of good health in mind think of an
indicator as
ldquohellipa measure that helps quantify the
achievement of a goalrdquo(Mark Friedman) Health Indicators Part I
Health Indicator is
bull ldquohellipa measure that helps quantify the
achievement of a goalrdquo -Mark Friedman
Power of indicators is comparisons bull Health indicators are essential for comparing health status - over time (trends) - geographic areas - groups of people and the focus on the most essential domains of health
Health Indicators Part I
A good indicator depends on
bull Availability of high quality data
bull Importance in measuring health status
bull Is well understood at the global level and various comparability options are possible
Health Indicators Part I
Health indicators are important because bull They are essential for monitoring and reporting data for decision making about population health bullTo inform policy makers to formulate evidence based policies and to promote accountability among governmental and non-governmental agencies bullThey are critical for setting priorities assessing the health status at baseline planning allocating resources and monitoring progress towards better health status goals bull Needed for assessing the health problems and trends to create awareness engage all the stakeholders in collaborative action and design interventions
Health Indicators Part I
Important Health Indicators for measurement of Health Status
bull Cause of death
ndash Obtained from death certification but limited because of incomplete coverage
bull Life expectancy at birth
ndash The average number of years a new-borns baby could expect to live if current trends in mortality were to continue for the rest of the new-borns life
bull Maternal mortality rate
ndash The number of women who die as a result of childbirth and pregnancy related complications per 100000 live births in a given year
Infant mortality rate rsaquo The number of deaths in infants under 1 year per 1000
live births for a given year
Neonatal mortality rate rsaquo The number of deaths among infants under 28 days in a
given year per 1000 live births in that year
Under five child mortality rate rsaquo The probability that a new-born will die before reaching
the age of five years expressed as a number per 1000 live births
Important Health Indicators for measurement of Health Status
Types of Health Indicators
Count Number Measure without a denominator
Rate Numerator is part of denominator Frequency of
occurrence of an event during specific time usually
expressed per 1000 population
Ratio Numerator is not included in denominator (sex
ratio)
Index Aggregation of measurement of specific
indicators
Health Indicators Part I
Indicators of Health
Global health indicators highlighting the health inequality
Global health indicators are improving
overall in the worldhellip
But not in all places not for all social
groups and not at the same speed
Health inequality
bullThere is a difference between the health status of one population compared to another population or difference between population subgroups
How to measure health inequality
bullMost measurement of health inequality involves the use of indicators to measure health
Health indicators within the Monitoring Evaluation and Review framework
Source Adapted from Monitoring evaluation and review of national health strategies a country-led platform for information and accountability Geneva World Health Organization 2011
INPUTS AND PROCESSES
OUTPUTS OUTCOMES IMPACT
bull Health financing
bull Health workforce
bull Infrastructure bull Information bull Governance
bull Service access and readiness
bull Service quality and safety
bull Coverage of interventions
bull Risk factors and behaviours
bull Health status bull Financial risk
protection bull Responsiveness
Indicators of Health - classification
bull Mortality indicators
bull Morbidity indicators
bull Disability indicators
bull Nutritional status indicators
bull Health care delivery indicators
bull Health care Utilization indicators
bull Indicators of social and mental health
bull Environmental indicators
bull Socio-economic indicators
bull Health policy indicators
bull Other indicators
Mortality Indicators
a Crude death rate
bull It is defined as the number of deaths per 1000 population
per year in a given community
bull Reducing the number of deaths in the population is an obvious goal of medicine and health care and success or failure to do so is a measure of a nations commitment to better health
Crude death rate = _Number of deaths (all causes)___ 1000
Estimated midyear population
Mortality Indicators
bull Age-specific death rate = ____number of deaths (25-44)_____ 1000
estimated midyear population (25-44)
bull Cause-specific death rate = __Number of deaths (specific cause)__ 100000
Estimated midyear population
Mortality Indicators
b Life expectancy
bull ldquoThe average number of years that will be lived by those born alive into a population if the current age-specific mortality rates persistldquo
bull Life expectancy is a good indicator of socio-economic development in general
bull A minimum life expectancy at birth of 60 years is the goal of Health for All by 2000AD
Mortality Indicators
c Infant Mortality rate bull It is the ratio of deaths under 1 year of age in a given year
to the total number of live births in the same year usually expressed as a rate per 1000 live births
bull It is one of the most universally accepted indicators of health status not only of infants but also of whole population and of the socioeconomic conditions under which they live
bull The global strategy of Health for All has suggested an infant mortality rate of not more than 50 per 1000 live births by 2000 AD
Mortality Indicators
d Child Mortality Rate
bull It is defined as the number of deaths at ages 1-4 years in a given year per 1000 children in that age group at the mid-point of the year concerned
e Maternal Mortality Rate
Maternal Mortality rate
bullMaternal deaths death of a woman 1048633 while pregnant or 1048633 within 42 days of termination of pregnancy 1048633 Irrespective of the duration or site of the pregnancy 1048633 From any cause related to or aggravated by the pregnancy or its management 1048633 Not from accidental causes bullNumber of women who die as a result of complications of pregnancy or childbearing in a given year per 1000 live births in that year bullRepresents both the obstetric risk
Morbidity Indicators
bull Mortality indicators do not reveal the burden of ill health in a community
bull The following morbidity rates are used for assessing ill health in the community
ndash Incidence and Prevalence
ndash Attendance rates at out-patient departments health centers etc
ndash Admission Readmission and Discharge rates
ndash Duration of stay in hospital and
Morbidity Indicators
bull Incidence rate = No of new cases of a disease _in a certain time period___ population at risk in same time period No of new and old cases of a disease
bull Prevalence rate = _________in a certain time period________ population at risk in same time period No of new cases in a narrowly defined
bull Attack rate = ______population during a specific time period______ population at risk in same time period
Disability Rates
bull Disability rates related to illness and injury
bull Used to supplement mortality and morbidity indicators
bull Examples
1 number of days of restricted activity
2 work-loss days (or school-loss days)
Nutritional Status Indicators
bull Anthropometric measurements of preschool children ndash eg weight height mid- arm circumference
bull Heights (and sometimes weights) of children at school entry
bull Prevalence of low birth weight (less than 25 kg)
Health Care Delivery Indicators
bull The frequently used indicators of health care delivery ndash Doctor-population ratio ndash Doctor-nurse ratio ndash Population-bed ratio ndash Population per health center ndash Population per traditional birth attendant
bull These indicators reflect the equity of distribution of
health resources in different parts of the country and of the provision of health care
Utilization rates
bull The extent of use of health services
bull Is expressed as the proportion of people in need of a service who actually receive it in given period usually a year
bull Health care utilization is also affected by factors such as availability and accessibility of health services and the attitude of an individual towards his health and the health care system
Utilization rates
bull Examples of utilization rates
bull proportion of infants who are fully immunized against the 6 EPI diseases
bull proportion of pregnant women who receive antenatal care or have their deliveries supervised by a trained birth attendant
bull bed-occupancy rate (ie average daily in-patient censusaverage number of beds)
bull bed turn-over ration (ie dischargesaverage beds)
Socio-economic Indicators bull These indicators do not directly measure health
But they are of great importance in the interpretation of the indicators of health care ndash rate of population increase ndash per capita GNP ndash level of unemployment ndash dependency ratio ndash literacy rates ndash family size ndash housing the number of persons per room ndash per capita calorie availability
Health Policy Indicators
bull Proportion of GNP spent on health services
bull Proportion of GNP spent on health-related activities (including water supply and sanitation housing and nutrition community development)
bull Proportion of total health resources devoted to primary health care
Who compiles health indicators
bullReports are compiled at every local level - Health departments foundations helliphellip
bullNational ndashgovernmentprivate partnerships
bull International ndash WHO
Data Sources for Common Indicators
bull National Vital Statistics System (Birth Mortality)
bull Census data
bull Surveys (Behavioral Risk Factor Survey--Adults and Youth
National Health Interview Survey National Health and
Nutrition Examination Survey National Survey of Childrens
Health National Immunization Survey)
bull Disease Surveillance Systems
bull Health services administrative data
Health Indicators Part I
Indicators are like a waterhellip Too little of it you die of thirst Too much you drown in it
By Building Health information system able to
generate a list of Essential indicators covering the basic information needs
Keep it straight forward and simple
Global population health and well-being are both determinants and consequences
of major demographic changes
1 Migration within and across countries
2 Women in the paid workforce
3 Decreases in fertility and increase in life expectancy in many countries
So whatrsquos the world going to look like in the next 20-40 yearshellipby 2025 or 2050
Increasingly urban
Increasingly old
Increasingly diverse with migration
Increasing women in workforce
Global trends in longevity
Global Declines in Fertility
Doomsday scenarios
bull Rising inequality
bull Fragile families and communities
bull New urban areas that canrsquot catch up quickly
bull Environmental consequences
bull Social exclusion and ldquodis- integrationrdquo
bull Increased conflict
Health Indicator is
bull ldquohellipa measure that helps quantify the
achievement of a goalrdquo -Mark Friedman
Power of indicators is comparisons bull Health indicators are essential for comparing health status - over time (trends) - geographic areas - groups of people and the focus on the most essential domains of health
Health Indicators Part I
A good indicator depends on
bull Availability of high quality data
bull Importance in measuring health status
bull Is well understood at the global level and various comparability options are possible
Health Indicators Part I
Health indicators are important because bull They are essential for monitoring and reporting data for decision making about population health bullTo inform policy makers to formulate evidence based policies and to promote accountability among governmental and non-governmental agencies bullThey are critical for setting priorities assessing the health status at baseline planning allocating resources and monitoring progress towards better health status goals bull Needed for assessing the health problems and trends to create awareness engage all the stakeholders in collaborative action and design interventions
Health Indicators Part I
Important Health Indicators for measurement of Health Status
bull Cause of death
ndash Obtained from death certification but limited because of incomplete coverage
bull Life expectancy at birth
ndash The average number of years a new-borns baby could expect to live if current trends in mortality were to continue for the rest of the new-borns life
bull Maternal mortality rate
ndash The number of women who die as a result of childbirth and pregnancy related complications per 100000 live births in a given year
Infant mortality rate rsaquo The number of deaths in infants under 1 year per 1000
live births for a given year
Neonatal mortality rate rsaquo The number of deaths among infants under 28 days in a
given year per 1000 live births in that year
Under five child mortality rate rsaquo The probability that a new-born will die before reaching
the age of five years expressed as a number per 1000 live births
Important Health Indicators for measurement of Health Status
Types of Health Indicators
Count Number Measure without a denominator
Rate Numerator is part of denominator Frequency of
occurrence of an event during specific time usually
expressed per 1000 population
Ratio Numerator is not included in denominator (sex
ratio)
Index Aggregation of measurement of specific
indicators
Health Indicators Part I
Indicators of Health
Global health indicators highlighting the health inequality
Global health indicators are improving
overall in the worldhellip
But not in all places not for all social
groups and not at the same speed
Health inequality
bullThere is a difference between the health status of one population compared to another population or difference between population subgroups
How to measure health inequality
bullMost measurement of health inequality involves the use of indicators to measure health
Health indicators within the Monitoring Evaluation and Review framework
Source Adapted from Monitoring evaluation and review of national health strategies a country-led platform for information and accountability Geneva World Health Organization 2011
INPUTS AND PROCESSES
OUTPUTS OUTCOMES IMPACT
bull Health financing
bull Health workforce
bull Infrastructure bull Information bull Governance
bull Service access and readiness
bull Service quality and safety
bull Coverage of interventions
bull Risk factors and behaviours
bull Health status bull Financial risk
protection bull Responsiveness
Indicators of Health - classification
bull Mortality indicators
bull Morbidity indicators
bull Disability indicators
bull Nutritional status indicators
bull Health care delivery indicators
bull Health care Utilization indicators
bull Indicators of social and mental health
bull Environmental indicators
bull Socio-economic indicators
bull Health policy indicators
bull Other indicators
Mortality Indicators
a Crude death rate
bull It is defined as the number of deaths per 1000 population
per year in a given community
bull Reducing the number of deaths in the population is an obvious goal of medicine and health care and success or failure to do so is a measure of a nations commitment to better health
Crude death rate = _Number of deaths (all causes)___ 1000
Estimated midyear population
Mortality Indicators
bull Age-specific death rate = ____number of deaths (25-44)_____ 1000
estimated midyear population (25-44)
bull Cause-specific death rate = __Number of deaths (specific cause)__ 100000
Estimated midyear population
Mortality Indicators
b Life expectancy
bull ldquoThe average number of years that will be lived by those born alive into a population if the current age-specific mortality rates persistldquo
bull Life expectancy is a good indicator of socio-economic development in general
bull A minimum life expectancy at birth of 60 years is the goal of Health for All by 2000AD
Mortality Indicators
c Infant Mortality rate bull It is the ratio of deaths under 1 year of age in a given year
to the total number of live births in the same year usually expressed as a rate per 1000 live births
bull It is one of the most universally accepted indicators of health status not only of infants but also of whole population and of the socioeconomic conditions under which they live
bull The global strategy of Health for All has suggested an infant mortality rate of not more than 50 per 1000 live births by 2000 AD
Mortality Indicators
d Child Mortality Rate
bull It is defined as the number of deaths at ages 1-4 years in a given year per 1000 children in that age group at the mid-point of the year concerned
e Maternal Mortality Rate
Maternal Mortality rate
bullMaternal deaths death of a woman 1048633 while pregnant or 1048633 within 42 days of termination of pregnancy 1048633 Irrespective of the duration or site of the pregnancy 1048633 From any cause related to or aggravated by the pregnancy or its management 1048633 Not from accidental causes bullNumber of women who die as a result of complications of pregnancy or childbearing in a given year per 1000 live births in that year bullRepresents both the obstetric risk
Morbidity Indicators
bull Mortality indicators do not reveal the burden of ill health in a community
bull The following morbidity rates are used for assessing ill health in the community
ndash Incidence and Prevalence
ndash Attendance rates at out-patient departments health centers etc
ndash Admission Readmission and Discharge rates
ndash Duration of stay in hospital and
Morbidity Indicators
bull Incidence rate = No of new cases of a disease _in a certain time period___ population at risk in same time period No of new and old cases of a disease
bull Prevalence rate = _________in a certain time period________ population at risk in same time period No of new cases in a narrowly defined
bull Attack rate = ______population during a specific time period______ population at risk in same time period
Disability Rates
bull Disability rates related to illness and injury
bull Used to supplement mortality and morbidity indicators
bull Examples
1 number of days of restricted activity
2 work-loss days (or school-loss days)
Nutritional Status Indicators
bull Anthropometric measurements of preschool children ndash eg weight height mid- arm circumference
bull Heights (and sometimes weights) of children at school entry
bull Prevalence of low birth weight (less than 25 kg)
Health Care Delivery Indicators
bull The frequently used indicators of health care delivery ndash Doctor-population ratio ndash Doctor-nurse ratio ndash Population-bed ratio ndash Population per health center ndash Population per traditional birth attendant
bull These indicators reflect the equity of distribution of
health resources in different parts of the country and of the provision of health care
Utilization rates
bull The extent of use of health services
bull Is expressed as the proportion of people in need of a service who actually receive it in given period usually a year
bull Health care utilization is also affected by factors such as availability and accessibility of health services and the attitude of an individual towards his health and the health care system
Utilization rates
bull Examples of utilization rates
bull proportion of infants who are fully immunized against the 6 EPI diseases
bull proportion of pregnant women who receive antenatal care or have their deliveries supervised by a trained birth attendant
bull bed-occupancy rate (ie average daily in-patient censusaverage number of beds)
bull bed turn-over ration (ie dischargesaverage beds)
Socio-economic Indicators bull These indicators do not directly measure health
But they are of great importance in the interpretation of the indicators of health care ndash rate of population increase ndash per capita GNP ndash level of unemployment ndash dependency ratio ndash literacy rates ndash family size ndash housing the number of persons per room ndash per capita calorie availability
Health Policy Indicators
bull Proportion of GNP spent on health services
bull Proportion of GNP spent on health-related activities (including water supply and sanitation housing and nutrition community development)
bull Proportion of total health resources devoted to primary health care
Who compiles health indicators
bullReports are compiled at every local level - Health departments foundations helliphellip
bullNational ndashgovernmentprivate partnerships
bull International ndash WHO
Data Sources for Common Indicators
bull National Vital Statistics System (Birth Mortality)
bull Census data
bull Surveys (Behavioral Risk Factor Survey--Adults and Youth
National Health Interview Survey National Health and
Nutrition Examination Survey National Survey of Childrens
Health National Immunization Survey)
bull Disease Surveillance Systems
bull Health services administrative data
Health Indicators Part I
Indicators are like a waterhellip Too little of it you die of thirst Too much you drown in it
By Building Health information system able to
generate a list of Essential indicators covering the basic information needs
Keep it straight forward and simple
Global population health and well-being are both determinants and consequences
of major demographic changes
1 Migration within and across countries
2 Women in the paid workforce
3 Decreases in fertility and increase in life expectancy in many countries
So whatrsquos the world going to look like in the next 20-40 yearshellipby 2025 or 2050
Increasingly urban
Increasingly old
Increasingly diverse with migration
Increasing women in workforce
Global trends in longevity
Global Declines in Fertility
Doomsday scenarios
bull Rising inequality
bull Fragile families and communities
bull New urban areas that canrsquot catch up quickly
bull Environmental consequences
bull Social exclusion and ldquodis- integrationrdquo
bull Increased conflict
A good indicator depends on
bull Availability of high quality data
bull Importance in measuring health status
bull Is well understood at the global level and various comparability options are possible
Health Indicators Part I
Health indicators are important because bull They are essential for monitoring and reporting data for decision making about population health bullTo inform policy makers to formulate evidence based policies and to promote accountability among governmental and non-governmental agencies bullThey are critical for setting priorities assessing the health status at baseline planning allocating resources and monitoring progress towards better health status goals bull Needed for assessing the health problems and trends to create awareness engage all the stakeholders in collaborative action and design interventions
Health Indicators Part I
Important Health Indicators for measurement of Health Status
bull Cause of death
ndash Obtained from death certification but limited because of incomplete coverage
bull Life expectancy at birth
ndash The average number of years a new-borns baby could expect to live if current trends in mortality were to continue for the rest of the new-borns life
bull Maternal mortality rate
ndash The number of women who die as a result of childbirth and pregnancy related complications per 100000 live births in a given year
Infant mortality rate rsaquo The number of deaths in infants under 1 year per 1000
live births for a given year
Neonatal mortality rate rsaquo The number of deaths among infants under 28 days in a
given year per 1000 live births in that year
Under five child mortality rate rsaquo The probability that a new-born will die before reaching
the age of five years expressed as a number per 1000 live births
Important Health Indicators for measurement of Health Status
Types of Health Indicators
Count Number Measure without a denominator
Rate Numerator is part of denominator Frequency of
occurrence of an event during specific time usually
expressed per 1000 population
Ratio Numerator is not included in denominator (sex
ratio)
Index Aggregation of measurement of specific
indicators
Health Indicators Part I
Indicators of Health
Global health indicators highlighting the health inequality
Global health indicators are improving
overall in the worldhellip
But not in all places not for all social
groups and not at the same speed
Health inequality
bullThere is a difference between the health status of one population compared to another population or difference between population subgroups
How to measure health inequality
bullMost measurement of health inequality involves the use of indicators to measure health
Health indicators within the Monitoring Evaluation and Review framework
Source Adapted from Monitoring evaluation and review of national health strategies a country-led platform for information and accountability Geneva World Health Organization 2011
INPUTS AND PROCESSES
OUTPUTS OUTCOMES IMPACT
bull Health financing
bull Health workforce
bull Infrastructure bull Information bull Governance
bull Service access and readiness
bull Service quality and safety
bull Coverage of interventions
bull Risk factors and behaviours
bull Health status bull Financial risk
protection bull Responsiveness
Indicators of Health - classification
bull Mortality indicators
bull Morbidity indicators
bull Disability indicators
bull Nutritional status indicators
bull Health care delivery indicators
bull Health care Utilization indicators
bull Indicators of social and mental health
bull Environmental indicators
bull Socio-economic indicators
bull Health policy indicators
bull Other indicators
Mortality Indicators
a Crude death rate
bull It is defined as the number of deaths per 1000 population
per year in a given community
bull Reducing the number of deaths in the population is an obvious goal of medicine and health care and success or failure to do so is a measure of a nations commitment to better health
Crude death rate = _Number of deaths (all causes)___ 1000
Estimated midyear population
Mortality Indicators
bull Age-specific death rate = ____number of deaths (25-44)_____ 1000
estimated midyear population (25-44)
bull Cause-specific death rate = __Number of deaths (specific cause)__ 100000
Estimated midyear population
Mortality Indicators
b Life expectancy
bull ldquoThe average number of years that will be lived by those born alive into a population if the current age-specific mortality rates persistldquo
bull Life expectancy is a good indicator of socio-economic development in general
bull A minimum life expectancy at birth of 60 years is the goal of Health for All by 2000AD
Mortality Indicators
c Infant Mortality rate bull It is the ratio of deaths under 1 year of age in a given year
to the total number of live births in the same year usually expressed as a rate per 1000 live births
bull It is one of the most universally accepted indicators of health status not only of infants but also of whole population and of the socioeconomic conditions under which they live
bull The global strategy of Health for All has suggested an infant mortality rate of not more than 50 per 1000 live births by 2000 AD
Mortality Indicators
d Child Mortality Rate
bull It is defined as the number of deaths at ages 1-4 years in a given year per 1000 children in that age group at the mid-point of the year concerned
e Maternal Mortality Rate
Maternal Mortality rate
bullMaternal deaths death of a woman 1048633 while pregnant or 1048633 within 42 days of termination of pregnancy 1048633 Irrespective of the duration or site of the pregnancy 1048633 From any cause related to or aggravated by the pregnancy or its management 1048633 Not from accidental causes bullNumber of women who die as a result of complications of pregnancy or childbearing in a given year per 1000 live births in that year bullRepresents both the obstetric risk
Morbidity Indicators
bull Mortality indicators do not reveal the burden of ill health in a community
bull The following morbidity rates are used for assessing ill health in the community
ndash Incidence and Prevalence
ndash Attendance rates at out-patient departments health centers etc
ndash Admission Readmission and Discharge rates
ndash Duration of stay in hospital and
Morbidity Indicators
bull Incidence rate = No of new cases of a disease _in a certain time period___ population at risk in same time period No of new and old cases of a disease
bull Prevalence rate = _________in a certain time period________ population at risk in same time period No of new cases in a narrowly defined
bull Attack rate = ______population during a specific time period______ population at risk in same time period
Disability Rates
bull Disability rates related to illness and injury
bull Used to supplement mortality and morbidity indicators
bull Examples
1 number of days of restricted activity
2 work-loss days (or school-loss days)
Nutritional Status Indicators
bull Anthropometric measurements of preschool children ndash eg weight height mid- arm circumference
bull Heights (and sometimes weights) of children at school entry
bull Prevalence of low birth weight (less than 25 kg)
Health Care Delivery Indicators
bull The frequently used indicators of health care delivery ndash Doctor-population ratio ndash Doctor-nurse ratio ndash Population-bed ratio ndash Population per health center ndash Population per traditional birth attendant
bull These indicators reflect the equity of distribution of
health resources in different parts of the country and of the provision of health care
Utilization rates
bull The extent of use of health services
bull Is expressed as the proportion of people in need of a service who actually receive it in given period usually a year
bull Health care utilization is also affected by factors such as availability and accessibility of health services and the attitude of an individual towards his health and the health care system
Utilization rates
bull Examples of utilization rates
bull proportion of infants who are fully immunized against the 6 EPI diseases
bull proportion of pregnant women who receive antenatal care or have their deliveries supervised by a trained birth attendant
bull bed-occupancy rate (ie average daily in-patient censusaverage number of beds)
bull bed turn-over ration (ie dischargesaverage beds)
Socio-economic Indicators bull These indicators do not directly measure health
But they are of great importance in the interpretation of the indicators of health care ndash rate of population increase ndash per capita GNP ndash level of unemployment ndash dependency ratio ndash literacy rates ndash family size ndash housing the number of persons per room ndash per capita calorie availability
Health Policy Indicators
bull Proportion of GNP spent on health services
bull Proportion of GNP spent on health-related activities (including water supply and sanitation housing and nutrition community development)
bull Proportion of total health resources devoted to primary health care
Who compiles health indicators
bullReports are compiled at every local level - Health departments foundations helliphellip
bullNational ndashgovernmentprivate partnerships
bull International ndash WHO
Data Sources for Common Indicators
bull National Vital Statistics System (Birth Mortality)
bull Census data
bull Surveys (Behavioral Risk Factor Survey--Adults and Youth
National Health Interview Survey National Health and
Nutrition Examination Survey National Survey of Childrens
Health National Immunization Survey)
bull Disease Surveillance Systems
bull Health services administrative data
Health Indicators Part I
Indicators are like a waterhellip Too little of it you die of thirst Too much you drown in it
By Building Health information system able to
generate a list of Essential indicators covering the basic information needs
Keep it straight forward and simple
Global population health and well-being are both determinants and consequences
of major demographic changes
1 Migration within and across countries
2 Women in the paid workforce
3 Decreases in fertility and increase in life expectancy in many countries
So whatrsquos the world going to look like in the next 20-40 yearshellipby 2025 or 2050
Increasingly urban
Increasingly old
Increasingly diverse with migration
Increasing women in workforce
Global trends in longevity
Global Declines in Fertility
Doomsday scenarios
bull Rising inequality
bull Fragile families and communities
bull New urban areas that canrsquot catch up quickly
bull Environmental consequences
bull Social exclusion and ldquodis- integrationrdquo
bull Increased conflict
Health indicators are important because bull They are essential for monitoring and reporting data for decision making about population health bullTo inform policy makers to formulate evidence based policies and to promote accountability among governmental and non-governmental agencies bullThey are critical for setting priorities assessing the health status at baseline planning allocating resources and monitoring progress towards better health status goals bull Needed for assessing the health problems and trends to create awareness engage all the stakeholders in collaborative action and design interventions
Health Indicators Part I
Important Health Indicators for measurement of Health Status
bull Cause of death
ndash Obtained from death certification but limited because of incomplete coverage
bull Life expectancy at birth
ndash The average number of years a new-borns baby could expect to live if current trends in mortality were to continue for the rest of the new-borns life
bull Maternal mortality rate
ndash The number of women who die as a result of childbirth and pregnancy related complications per 100000 live births in a given year
Infant mortality rate rsaquo The number of deaths in infants under 1 year per 1000
live births for a given year
Neonatal mortality rate rsaquo The number of deaths among infants under 28 days in a
given year per 1000 live births in that year
Under five child mortality rate rsaquo The probability that a new-born will die before reaching
the age of five years expressed as a number per 1000 live births
Important Health Indicators for measurement of Health Status
Types of Health Indicators
Count Number Measure without a denominator
Rate Numerator is part of denominator Frequency of
occurrence of an event during specific time usually
expressed per 1000 population
Ratio Numerator is not included in denominator (sex
ratio)
Index Aggregation of measurement of specific
indicators
Health Indicators Part I
Indicators of Health
Global health indicators highlighting the health inequality
Global health indicators are improving
overall in the worldhellip
But not in all places not for all social
groups and not at the same speed
Health inequality
bullThere is a difference between the health status of one population compared to another population or difference between population subgroups
How to measure health inequality
bullMost measurement of health inequality involves the use of indicators to measure health
Health indicators within the Monitoring Evaluation and Review framework
Source Adapted from Monitoring evaluation and review of national health strategies a country-led platform for information and accountability Geneva World Health Organization 2011
INPUTS AND PROCESSES
OUTPUTS OUTCOMES IMPACT
bull Health financing
bull Health workforce
bull Infrastructure bull Information bull Governance
bull Service access and readiness
bull Service quality and safety
bull Coverage of interventions
bull Risk factors and behaviours
bull Health status bull Financial risk
protection bull Responsiveness
Indicators of Health - classification
bull Mortality indicators
bull Morbidity indicators
bull Disability indicators
bull Nutritional status indicators
bull Health care delivery indicators
bull Health care Utilization indicators
bull Indicators of social and mental health
bull Environmental indicators
bull Socio-economic indicators
bull Health policy indicators
bull Other indicators
Mortality Indicators
a Crude death rate
bull It is defined as the number of deaths per 1000 population
per year in a given community
bull Reducing the number of deaths in the population is an obvious goal of medicine and health care and success or failure to do so is a measure of a nations commitment to better health
Crude death rate = _Number of deaths (all causes)___ 1000
Estimated midyear population
Mortality Indicators
bull Age-specific death rate = ____number of deaths (25-44)_____ 1000
estimated midyear population (25-44)
bull Cause-specific death rate = __Number of deaths (specific cause)__ 100000
Estimated midyear population
Mortality Indicators
b Life expectancy
bull ldquoThe average number of years that will be lived by those born alive into a population if the current age-specific mortality rates persistldquo
bull Life expectancy is a good indicator of socio-economic development in general
bull A minimum life expectancy at birth of 60 years is the goal of Health for All by 2000AD
Mortality Indicators
c Infant Mortality rate bull It is the ratio of deaths under 1 year of age in a given year
to the total number of live births in the same year usually expressed as a rate per 1000 live births
bull It is one of the most universally accepted indicators of health status not only of infants but also of whole population and of the socioeconomic conditions under which they live
bull The global strategy of Health for All has suggested an infant mortality rate of not more than 50 per 1000 live births by 2000 AD
Mortality Indicators
d Child Mortality Rate
bull It is defined as the number of deaths at ages 1-4 years in a given year per 1000 children in that age group at the mid-point of the year concerned
e Maternal Mortality Rate
Maternal Mortality rate
bullMaternal deaths death of a woman 1048633 while pregnant or 1048633 within 42 days of termination of pregnancy 1048633 Irrespective of the duration or site of the pregnancy 1048633 From any cause related to or aggravated by the pregnancy or its management 1048633 Not from accidental causes bullNumber of women who die as a result of complications of pregnancy or childbearing in a given year per 1000 live births in that year bullRepresents both the obstetric risk
Morbidity Indicators
bull Mortality indicators do not reveal the burden of ill health in a community
bull The following morbidity rates are used for assessing ill health in the community
ndash Incidence and Prevalence
ndash Attendance rates at out-patient departments health centers etc
ndash Admission Readmission and Discharge rates
ndash Duration of stay in hospital and
Morbidity Indicators
bull Incidence rate = No of new cases of a disease _in a certain time period___ population at risk in same time period No of new and old cases of a disease
bull Prevalence rate = _________in a certain time period________ population at risk in same time period No of new cases in a narrowly defined
bull Attack rate = ______population during a specific time period______ population at risk in same time period
Disability Rates
bull Disability rates related to illness and injury
bull Used to supplement mortality and morbidity indicators
bull Examples
1 number of days of restricted activity
2 work-loss days (or school-loss days)
Nutritional Status Indicators
bull Anthropometric measurements of preschool children ndash eg weight height mid- arm circumference
bull Heights (and sometimes weights) of children at school entry
bull Prevalence of low birth weight (less than 25 kg)
Health Care Delivery Indicators
bull The frequently used indicators of health care delivery ndash Doctor-population ratio ndash Doctor-nurse ratio ndash Population-bed ratio ndash Population per health center ndash Population per traditional birth attendant
bull These indicators reflect the equity of distribution of
health resources in different parts of the country and of the provision of health care
Utilization rates
bull The extent of use of health services
bull Is expressed as the proportion of people in need of a service who actually receive it in given period usually a year
bull Health care utilization is also affected by factors such as availability and accessibility of health services and the attitude of an individual towards his health and the health care system
Utilization rates
bull Examples of utilization rates
bull proportion of infants who are fully immunized against the 6 EPI diseases
bull proportion of pregnant women who receive antenatal care or have their deliveries supervised by a trained birth attendant
bull bed-occupancy rate (ie average daily in-patient censusaverage number of beds)
bull bed turn-over ration (ie dischargesaverage beds)
Socio-economic Indicators bull These indicators do not directly measure health
But they are of great importance in the interpretation of the indicators of health care ndash rate of population increase ndash per capita GNP ndash level of unemployment ndash dependency ratio ndash literacy rates ndash family size ndash housing the number of persons per room ndash per capita calorie availability
Health Policy Indicators
bull Proportion of GNP spent on health services
bull Proportion of GNP spent on health-related activities (including water supply and sanitation housing and nutrition community development)
bull Proportion of total health resources devoted to primary health care
Who compiles health indicators
bullReports are compiled at every local level - Health departments foundations helliphellip
bullNational ndashgovernmentprivate partnerships
bull International ndash WHO
Data Sources for Common Indicators
bull National Vital Statistics System (Birth Mortality)
bull Census data
bull Surveys (Behavioral Risk Factor Survey--Adults and Youth
National Health Interview Survey National Health and
Nutrition Examination Survey National Survey of Childrens
Health National Immunization Survey)
bull Disease Surveillance Systems
bull Health services administrative data
Health Indicators Part I
Indicators are like a waterhellip Too little of it you die of thirst Too much you drown in it
By Building Health information system able to
generate a list of Essential indicators covering the basic information needs
Keep it straight forward and simple
Global population health and well-being are both determinants and consequences
of major demographic changes
1 Migration within and across countries
2 Women in the paid workforce
3 Decreases in fertility and increase in life expectancy in many countries
So whatrsquos the world going to look like in the next 20-40 yearshellipby 2025 or 2050
Increasingly urban
Increasingly old
Increasingly diverse with migration
Increasing women in workforce
Global trends in longevity
Global Declines in Fertility
Doomsday scenarios
bull Rising inequality
bull Fragile families and communities
bull New urban areas that canrsquot catch up quickly
bull Environmental consequences
bull Social exclusion and ldquodis- integrationrdquo
bull Increased conflict
Important Health Indicators for measurement of Health Status
bull Cause of death
ndash Obtained from death certification but limited because of incomplete coverage
bull Life expectancy at birth
ndash The average number of years a new-borns baby could expect to live if current trends in mortality were to continue for the rest of the new-borns life
bull Maternal mortality rate
ndash The number of women who die as a result of childbirth and pregnancy related complications per 100000 live births in a given year
Infant mortality rate rsaquo The number of deaths in infants under 1 year per 1000
live births for a given year
Neonatal mortality rate rsaquo The number of deaths among infants under 28 days in a
given year per 1000 live births in that year
Under five child mortality rate rsaquo The probability that a new-born will die before reaching
the age of five years expressed as a number per 1000 live births
Important Health Indicators for measurement of Health Status
Types of Health Indicators
Count Number Measure without a denominator
Rate Numerator is part of denominator Frequency of
occurrence of an event during specific time usually
expressed per 1000 population
Ratio Numerator is not included in denominator (sex
ratio)
Index Aggregation of measurement of specific
indicators
Health Indicators Part I
Indicators of Health
Global health indicators highlighting the health inequality
Global health indicators are improving
overall in the worldhellip
But not in all places not for all social
groups and not at the same speed
Health inequality
bullThere is a difference between the health status of one population compared to another population or difference between population subgroups
How to measure health inequality
bullMost measurement of health inequality involves the use of indicators to measure health
Health indicators within the Monitoring Evaluation and Review framework
Source Adapted from Monitoring evaluation and review of national health strategies a country-led platform for information and accountability Geneva World Health Organization 2011
INPUTS AND PROCESSES
OUTPUTS OUTCOMES IMPACT
bull Health financing
bull Health workforce
bull Infrastructure bull Information bull Governance
bull Service access and readiness
bull Service quality and safety
bull Coverage of interventions
bull Risk factors and behaviours
bull Health status bull Financial risk
protection bull Responsiveness
Indicators of Health - classification
bull Mortality indicators
bull Morbidity indicators
bull Disability indicators
bull Nutritional status indicators
bull Health care delivery indicators
bull Health care Utilization indicators
bull Indicators of social and mental health
bull Environmental indicators
bull Socio-economic indicators
bull Health policy indicators
bull Other indicators
Mortality Indicators
a Crude death rate
bull It is defined as the number of deaths per 1000 population
per year in a given community
bull Reducing the number of deaths in the population is an obvious goal of medicine and health care and success or failure to do so is a measure of a nations commitment to better health
Crude death rate = _Number of deaths (all causes)___ 1000
Estimated midyear population
Mortality Indicators
bull Age-specific death rate = ____number of deaths (25-44)_____ 1000
estimated midyear population (25-44)
bull Cause-specific death rate = __Number of deaths (specific cause)__ 100000
Estimated midyear population
Mortality Indicators
b Life expectancy
bull ldquoThe average number of years that will be lived by those born alive into a population if the current age-specific mortality rates persistldquo
bull Life expectancy is a good indicator of socio-economic development in general
bull A minimum life expectancy at birth of 60 years is the goal of Health for All by 2000AD
Mortality Indicators
c Infant Mortality rate bull It is the ratio of deaths under 1 year of age in a given year
to the total number of live births in the same year usually expressed as a rate per 1000 live births
bull It is one of the most universally accepted indicators of health status not only of infants but also of whole population and of the socioeconomic conditions under which they live
bull The global strategy of Health for All has suggested an infant mortality rate of not more than 50 per 1000 live births by 2000 AD
Mortality Indicators
d Child Mortality Rate
bull It is defined as the number of deaths at ages 1-4 years in a given year per 1000 children in that age group at the mid-point of the year concerned
e Maternal Mortality Rate
Maternal Mortality rate
bullMaternal deaths death of a woman 1048633 while pregnant or 1048633 within 42 days of termination of pregnancy 1048633 Irrespective of the duration or site of the pregnancy 1048633 From any cause related to or aggravated by the pregnancy or its management 1048633 Not from accidental causes bullNumber of women who die as a result of complications of pregnancy or childbearing in a given year per 1000 live births in that year bullRepresents both the obstetric risk
Morbidity Indicators
bull Mortality indicators do not reveal the burden of ill health in a community
bull The following morbidity rates are used for assessing ill health in the community
ndash Incidence and Prevalence
ndash Attendance rates at out-patient departments health centers etc
ndash Admission Readmission and Discharge rates
ndash Duration of stay in hospital and
Morbidity Indicators
bull Incidence rate = No of new cases of a disease _in a certain time period___ population at risk in same time period No of new and old cases of a disease
bull Prevalence rate = _________in a certain time period________ population at risk in same time period No of new cases in a narrowly defined
bull Attack rate = ______population during a specific time period______ population at risk in same time period
Disability Rates
bull Disability rates related to illness and injury
bull Used to supplement mortality and morbidity indicators
bull Examples
1 number of days of restricted activity
2 work-loss days (or school-loss days)
Nutritional Status Indicators
bull Anthropometric measurements of preschool children ndash eg weight height mid- arm circumference
bull Heights (and sometimes weights) of children at school entry
bull Prevalence of low birth weight (less than 25 kg)
Health Care Delivery Indicators
bull The frequently used indicators of health care delivery ndash Doctor-population ratio ndash Doctor-nurse ratio ndash Population-bed ratio ndash Population per health center ndash Population per traditional birth attendant
bull These indicators reflect the equity of distribution of
health resources in different parts of the country and of the provision of health care
Utilization rates
bull The extent of use of health services
bull Is expressed as the proportion of people in need of a service who actually receive it in given period usually a year
bull Health care utilization is also affected by factors such as availability and accessibility of health services and the attitude of an individual towards his health and the health care system
Utilization rates
bull Examples of utilization rates
bull proportion of infants who are fully immunized against the 6 EPI diseases
bull proportion of pregnant women who receive antenatal care or have their deliveries supervised by a trained birth attendant
bull bed-occupancy rate (ie average daily in-patient censusaverage number of beds)
bull bed turn-over ration (ie dischargesaverage beds)
Socio-economic Indicators bull These indicators do not directly measure health
But they are of great importance in the interpretation of the indicators of health care ndash rate of population increase ndash per capita GNP ndash level of unemployment ndash dependency ratio ndash literacy rates ndash family size ndash housing the number of persons per room ndash per capita calorie availability
Health Policy Indicators
bull Proportion of GNP spent on health services
bull Proportion of GNP spent on health-related activities (including water supply and sanitation housing and nutrition community development)
bull Proportion of total health resources devoted to primary health care
Who compiles health indicators
bullReports are compiled at every local level - Health departments foundations helliphellip
bullNational ndashgovernmentprivate partnerships
bull International ndash WHO
Data Sources for Common Indicators
bull National Vital Statistics System (Birth Mortality)
bull Census data
bull Surveys (Behavioral Risk Factor Survey--Adults and Youth
National Health Interview Survey National Health and
Nutrition Examination Survey National Survey of Childrens
Health National Immunization Survey)
bull Disease Surveillance Systems
bull Health services administrative data
Health Indicators Part I
Indicators are like a waterhellip Too little of it you die of thirst Too much you drown in it
By Building Health information system able to
generate a list of Essential indicators covering the basic information needs
Keep it straight forward and simple
Global population health and well-being are both determinants and consequences
of major demographic changes
1 Migration within and across countries
2 Women in the paid workforce
3 Decreases in fertility and increase in life expectancy in many countries
So whatrsquos the world going to look like in the next 20-40 yearshellipby 2025 or 2050
Increasingly urban
Increasingly old
Increasingly diverse with migration
Increasing women in workforce
Global trends in longevity
Global Declines in Fertility
Doomsday scenarios
bull Rising inequality
bull Fragile families and communities
bull New urban areas that canrsquot catch up quickly
bull Environmental consequences
bull Social exclusion and ldquodis- integrationrdquo
bull Increased conflict
Infant mortality rate rsaquo The number of deaths in infants under 1 year per 1000
live births for a given year
Neonatal mortality rate rsaquo The number of deaths among infants under 28 days in a
given year per 1000 live births in that year
Under five child mortality rate rsaquo The probability that a new-born will die before reaching
the age of five years expressed as a number per 1000 live births
Important Health Indicators for measurement of Health Status
Types of Health Indicators
Count Number Measure without a denominator
Rate Numerator is part of denominator Frequency of
occurrence of an event during specific time usually
expressed per 1000 population
Ratio Numerator is not included in denominator (sex
ratio)
Index Aggregation of measurement of specific
indicators
Health Indicators Part I
Indicators of Health
Global health indicators highlighting the health inequality
Global health indicators are improving
overall in the worldhellip
But not in all places not for all social
groups and not at the same speed
Health inequality
bullThere is a difference between the health status of one population compared to another population or difference between population subgroups
How to measure health inequality
bullMost measurement of health inequality involves the use of indicators to measure health
Health indicators within the Monitoring Evaluation and Review framework
Source Adapted from Monitoring evaluation and review of national health strategies a country-led platform for information and accountability Geneva World Health Organization 2011
INPUTS AND PROCESSES
OUTPUTS OUTCOMES IMPACT
bull Health financing
bull Health workforce
bull Infrastructure bull Information bull Governance
bull Service access and readiness
bull Service quality and safety
bull Coverage of interventions
bull Risk factors and behaviours
bull Health status bull Financial risk
protection bull Responsiveness
Indicators of Health - classification
bull Mortality indicators
bull Morbidity indicators
bull Disability indicators
bull Nutritional status indicators
bull Health care delivery indicators
bull Health care Utilization indicators
bull Indicators of social and mental health
bull Environmental indicators
bull Socio-economic indicators
bull Health policy indicators
bull Other indicators
Mortality Indicators
a Crude death rate
bull It is defined as the number of deaths per 1000 population
per year in a given community
bull Reducing the number of deaths in the population is an obvious goal of medicine and health care and success or failure to do so is a measure of a nations commitment to better health
Crude death rate = _Number of deaths (all causes)___ 1000
Estimated midyear population
Mortality Indicators
bull Age-specific death rate = ____number of deaths (25-44)_____ 1000
estimated midyear population (25-44)
bull Cause-specific death rate = __Number of deaths (specific cause)__ 100000
Estimated midyear population
Mortality Indicators
b Life expectancy
bull ldquoThe average number of years that will be lived by those born alive into a population if the current age-specific mortality rates persistldquo
bull Life expectancy is a good indicator of socio-economic development in general
bull A minimum life expectancy at birth of 60 years is the goal of Health for All by 2000AD
Mortality Indicators
c Infant Mortality rate bull It is the ratio of deaths under 1 year of age in a given year
to the total number of live births in the same year usually expressed as a rate per 1000 live births
bull It is one of the most universally accepted indicators of health status not only of infants but also of whole population and of the socioeconomic conditions under which they live
bull The global strategy of Health for All has suggested an infant mortality rate of not more than 50 per 1000 live births by 2000 AD
Mortality Indicators
d Child Mortality Rate
bull It is defined as the number of deaths at ages 1-4 years in a given year per 1000 children in that age group at the mid-point of the year concerned
e Maternal Mortality Rate
Maternal Mortality rate
bullMaternal deaths death of a woman 1048633 while pregnant or 1048633 within 42 days of termination of pregnancy 1048633 Irrespective of the duration or site of the pregnancy 1048633 From any cause related to or aggravated by the pregnancy or its management 1048633 Not from accidental causes bullNumber of women who die as a result of complications of pregnancy or childbearing in a given year per 1000 live births in that year bullRepresents both the obstetric risk
Morbidity Indicators
bull Mortality indicators do not reveal the burden of ill health in a community
bull The following morbidity rates are used for assessing ill health in the community
ndash Incidence and Prevalence
ndash Attendance rates at out-patient departments health centers etc
ndash Admission Readmission and Discharge rates
ndash Duration of stay in hospital and
Morbidity Indicators
bull Incidence rate = No of new cases of a disease _in a certain time period___ population at risk in same time period No of new and old cases of a disease
bull Prevalence rate = _________in a certain time period________ population at risk in same time period No of new cases in a narrowly defined
bull Attack rate = ______population during a specific time period______ population at risk in same time period
Disability Rates
bull Disability rates related to illness and injury
bull Used to supplement mortality and morbidity indicators
bull Examples
1 number of days of restricted activity
2 work-loss days (or school-loss days)
Nutritional Status Indicators
bull Anthropometric measurements of preschool children ndash eg weight height mid- arm circumference
bull Heights (and sometimes weights) of children at school entry
bull Prevalence of low birth weight (less than 25 kg)
Health Care Delivery Indicators
bull The frequently used indicators of health care delivery ndash Doctor-population ratio ndash Doctor-nurse ratio ndash Population-bed ratio ndash Population per health center ndash Population per traditional birth attendant
bull These indicators reflect the equity of distribution of
health resources in different parts of the country and of the provision of health care
Utilization rates
bull The extent of use of health services
bull Is expressed as the proportion of people in need of a service who actually receive it in given period usually a year
bull Health care utilization is also affected by factors such as availability and accessibility of health services and the attitude of an individual towards his health and the health care system
Utilization rates
bull Examples of utilization rates
bull proportion of infants who are fully immunized against the 6 EPI diseases
bull proportion of pregnant women who receive antenatal care or have their deliveries supervised by a trained birth attendant
bull bed-occupancy rate (ie average daily in-patient censusaverage number of beds)
bull bed turn-over ration (ie dischargesaverage beds)
Socio-economic Indicators bull These indicators do not directly measure health
But they are of great importance in the interpretation of the indicators of health care ndash rate of population increase ndash per capita GNP ndash level of unemployment ndash dependency ratio ndash literacy rates ndash family size ndash housing the number of persons per room ndash per capita calorie availability
Health Policy Indicators
bull Proportion of GNP spent on health services
bull Proportion of GNP spent on health-related activities (including water supply and sanitation housing and nutrition community development)
bull Proportion of total health resources devoted to primary health care
Who compiles health indicators
bullReports are compiled at every local level - Health departments foundations helliphellip
bullNational ndashgovernmentprivate partnerships
bull International ndash WHO
Data Sources for Common Indicators
bull National Vital Statistics System (Birth Mortality)
bull Census data
bull Surveys (Behavioral Risk Factor Survey--Adults and Youth
National Health Interview Survey National Health and
Nutrition Examination Survey National Survey of Childrens
Health National Immunization Survey)
bull Disease Surveillance Systems
bull Health services administrative data
Health Indicators Part I
Indicators are like a waterhellip Too little of it you die of thirst Too much you drown in it
By Building Health information system able to
generate a list of Essential indicators covering the basic information needs
Keep it straight forward and simple
Global population health and well-being are both determinants and consequences
of major demographic changes
1 Migration within and across countries
2 Women in the paid workforce
3 Decreases in fertility and increase in life expectancy in many countries
So whatrsquos the world going to look like in the next 20-40 yearshellipby 2025 or 2050
Increasingly urban
Increasingly old
Increasingly diverse with migration
Increasing women in workforce
Global trends in longevity
Global Declines in Fertility
Doomsday scenarios
bull Rising inequality
bull Fragile families and communities
bull New urban areas that canrsquot catch up quickly
bull Environmental consequences
bull Social exclusion and ldquodis- integrationrdquo
bull Increased conflict
Types of Health Indicators
Count Number Measure without a denominator
Rate Numerator is part of denominator Frequency of
occurrence of an event during specific time usually
expressed per 1000 population
Ratio Numerator is not included in denominator (sex
ratio)
Index Aggregation of measurement of specific
indicators
Health Indicators Part I
Indicators of Health
Global health indicators highlighting the health inequality
Global health indicators are improving
overall in the worldhellip
But not in all places not for all social
groups and not at the same speed
Health inequality
bullThere is a difference between the health status of one population compared to another population or difference between population subgroups
How to measure health inequality
bullMost measurement of health inequality involves the use of indicators to measure health
Health indicators within the Monitoring Evaluation and Review framework
Source Adapted from Monitoring evaluation and review of national health strategies a country-led platform for information and accountability Geneva World Health Organization 2011
INPUTS AND PROCESSES
OUTPUTS OUTCOMES IMPACT
bull Health financing
bull Health workforce
bull Infrastructure bull Information bull Governance
bull Service access and readiness
bull Service quality and safety
bull Coverage of interventions
bull Risk factors and behaviours
bull Health status bull Financial risk
protection bull Responsiveness
Indicators of Health - classification
bull Mortality indicators
bull Morbidity indicators
bull Disability indicators
bull Nutritional status indicators
bull Health care delivery indicators
bull Health care Utilization indicators
bull Indicators of social and mental health
bull Environmental indicators
bull Socio-economic indicators
bull Health policy indicators
bull Other indicators
Mortality Indicators
a Crude death rate
bull It is defined as the number of deaths per 1000 population
per year in a given community
bull Reducing the number of deaths in the population is an obvious goal of medicine and health care and success or failure to do so is a measure of a nations commitment to better health
Crude death rate = _Number of deaths (all causes)___ 1000
Estimated midyear population
Mortality Indicators
bull Age-specific death rate = ____number of deaths (25-44)_____ 1000
estimated midyear population (25-44)
bull Cause-specific death rate = __Number of deaths (specific cause)__ 100000
Estimated midyear population
Mortality Indicators
b Life expectancy
bull ldquoThe average number of years that will be lived by those born alive into a population if the current age-specific mortality rates persistldquo
bull Life expectancy is a good indicator of socio-economic development in general
bull A minimum life expectancy at birth of 60 years is the goal of Health for All by 2000AD
Mortality Indicators
c Infant Mortality rate bull It is the ratio of deaths under 1 year of age in a given year
to the total number of live births in the same year usually expressed as a rate per 1000 live births
bull It is one of the most universally accepted indicators of health status not only of infants but also of whole population and of the socioeconomic conditions under which they live
bull The global strategy of Health for All has suggested an infant mortality rate of not more than 50 per 1000 live births by 2000 AD
Mortality Indicators
d Child Mortality Rate
bull It is defined as the number of deaths at ages 1-4 years in a given year per 1000 children in that age group at the mid-point of the year concerned
e Maternal Mortality Rate
Maternal Mortality rate
bullMaternal deaths death of a woman 1048633 while pregnant or 1048633 within 42 days of termination of pregnancy 1048633 Irrespective of the duration or site of the pregnancy 1048633 From any cause related to or aggravated by the pregnancy or its management 1048633 Not from accidental causes bullNumber of women who die as a result of complications of pregnancy or childbearing in a given year per 1000 live births in that year bullRepresents both the obstetric risk
Morbidity Indicators
bull Mortality indicators do not reveal the burden of ill health in a community
bull The following morbidity rates are used for assessing ill health in the community
ndash Incidence and Prevalence
ndash Attendance rates at out-patient departments health centers etc
ndash Admission Readmission and Discharge rates
ndash Duration of stay in hospital and
Morbidity Indicators
bull Incidence rate = No of new cases of a disease _in a certain time period___ population at risk in same time period No of new and old cases of a disease
bull Prevalence rate = _________in a certain time period________ population at risk in same time period No of new cases in a narrowly defined
bull Attack rate = ______population during a specific time period______ population at risk in same time period
Disability Rates
bull Disability rates related to illness and injury
bull Used to supplement mortality and morbidity indicators
bull Examples
1 number of days of restricted activity
2 work-loss days (or school-loss days)
Nutritional Status Indicators
bull Anthropometric measurements of preschool children ndash eg weight height mid- arm circumference
bull Heights (and sometimes weights) of children at school entry
bull Prevalence of low birth weight (less than 25 kg)
Health Care Delivery Indicators
bull The frequently used indicators of health care delivery ndash Doctor-population ratio ndash Doctor-nurse ratio ndash Population-bed ratio ndash Population per health center ndash Population per traditional birth attendant
bull These indicators reflect the equity of distribution of
health resources in different parts of the country and of the provision of health care
Utilization rates
bull The extent of use of health services
bull Is expressed as the proportion of people in need of a service who actually receive it in given period usually a year
bull Health care utilization is also affected by factors such as availability and accessibility of health services and the attitude of an individual towards his health and the health care system
Utilization rates
bull Examples of utilization rates
bull proportion of infants who are fully immunized against the 6 EPI diseases
bull proportion of pregnant women who receive antenatal care or have their deliveries supervised by a trained birth attendant
bull bed-occupancy rate (ie average daily in-patient censusaverage number of beds)
bull bed turn-over ration (ie dischargesaverage beds)
Socio-economic Indicators bull These indicators do not directly measure health
But they are of great importance in the interpretation of the indicators of health care ndash rate of population increase ndash per capita GNP ndash level of unemployment ndash dependency ratio ndash literacy rates ndash family size ndash housing the number of persons per room ndash per capita calorie availability
Health Policy Indicators
bull Proportion of GNP spent on health services
bull Proportion of GNP spent on health-related activities (including water supply and sanitation housing and nutrition community development)
bull Proportion of total health resources devoted to primary health care
Who compiles health indicators
bullReports are compiled at every local level - Health departments foundations helliphellip
bullNational ndashgovernmentprivate partnerships
bull International ndash WHO
Data Sources for Common Indicators
bull National Vital Statistics System (Birth Mortality)
bull Census data
bull Surveys (Behavioral Risk Factor Survey--Adults and Youth
National Health Interview Survey National Health and
Nutrition Examination Survey National Survey of Childrens
Health National Immunization Survey)
bull Disease Surveillance Systems
bull Health services administrative data
Health Indicators Part I
Indicators are like a waterhellip Too little of it you die of thirst Too much you drown in it
By Building Health information system able to
generate a list of Essential indicators covering the basic information needs
Keep it straight forward and simple
Global population health and well-being are both determinants and consequences
of major demographic changes
1 Migration within and across countries
2 Women in the paid workforce
3 Decreases in fertility and increase in life expectancy in many countries
So whatrsquos the world going to look like in the next 20-40 yearshellipby 2025 or 2050
Increasingly urban
Increasingly old
Increasingly diverse with migration
Increasing women in workforce
Global trends in longevity
Global Declines in Fertility
Doomsday scenarios
bull Rising inequality
bull Fragile families and communities
bull New urban areas that canrsquot catch up quickly
bull Environmental consequences
bull Social exclusion and ldquodis- integrationrdquo
bull Increased conflict
Indicators of Health
Global health indicators highlighting the health inequality
Global health indicators are improving
overall in the worldhellip
But not in all places not for all social
groups and not at the same speed
Health inequality
bullThere is a difference between the health status of one population compared to another population or difference between population subgroups
How to measure health inequality
bullMost measurement of health inequality involves the use of indicators to measure health
Health indicators within the Monitoring Evaluation and Review framework
Source Adapted from Monitoring evaluation and review of national health strategies a country-led platform for information and accountability Geneva World Health Organization 2011
INPUTS AND PROCESSES
OUTPUTS OUTCOMES IMPACT
bull Health financing
bull Health workforce
bull Infrastructure bull Information bull Governance
bull Service access and readiness
bull Service quality and safety
bull Coverage of interventions
bull Risk factors and behaviours
bull Health status bull Financial risk
protection bull Responsiveness
Indicators of Health - classification
bull Mortality indicators
bull Morbidity indicators
bull Disability indicators
bull Nutritional status indicators
bull Health care delivery indicators
bull Health care Utilization indicators
bull Indicators of social and mental health
bull Environmental indicators
bull Socio-economic indicators
bull Health policy indicators
bull Other indicators
Mortality Indicators
a Crude death rate
bull It is defined as the number of deaths per 1000 population
per year in a given community
bull Reducing the number of deaths in the population is an obvious goal of medicine and health care and success or failure to do so is a measure of a nations commitment to better health
Crude death rate = _Number of deaths (all causes)___ 1000
Estimated midyear population
Mortality Indicators
bull Age-specific death rate = ____number of deaths (25-44)_____ 1000
estimated midyear population (25-44)
bull Cause-specific death rate = __Number of deaths (specific cause)__ 100000
Estimated midyear population
Mortality Indicators
b Life expectancy
bull ldquoThe average number of years that will be lived by those born alive into a population if the current age-specific mortality rates persistldquo
bull Life expectancy is a good indicator of socio-economic development in general
bull A minimum life expectancy at birth of 60 years is the goal of Health for All by 2000AD
Mortality Indicators
c Infant Mortality rate bull It is the ratio of deaths under 1 year of age in a given year
to the total number of live births in the same year usually expressed as a rate per 1000 live births
bull It is one of the most universally accepted indicators of health status not only of infants but also of whole population and of the socioeconomic conditions under which they live
bull The global strategy of Health for All has suggested an infant mortality rate of not more than 50 per 1000 live births by 2000 AD
Mortality Indicators
d Child Mortality Rate
bull It is defined as the number of deaths at ages 1-4 years in a given year per 1000 children in that age group at the mid-point of the year concerned
e Maternal Mortality Rate
Maternal Mortality rate
bullMaternal deaths death of a woman 1048633 while pregnant or 1048633 within 42 days of termination of pregnancy 1048633 Irrespective of the duration or site of the pregnancy 1048633 From any cause related to or aggravated by the pregnancy or its management 1048633 Not from accidental causes bullNumber of women who die as a result of complications of pregnancy or childbearing in a given year per 1000 live births in that year bullRepresents both the obstetric risk
Morbidity Indicators
bull Mortality indicators do not reveal the burden of ill health in a community
bull The following morbidity rates are used for assessing ill health in the community
ndash Incidence and Prevalence
ndash Attendance rates at out-patient departments health centers etc
ndash Admission Readmission and Discharge rates
ndash Duration of stay in hospital and
Morbidity Indicators
bull Incidence rate = No of new cases of a disease _in a certain time period___ population at risk in same time period No of new and old cases of a disease
bull Prevalence rate = _________in a certain time period________ population at risk in same time period No of new cases in a narrowly defined
bull Attack rate = ______population during a specific time period______ population at risk in same time period
Disability Rates
bull Disability rates related to illness and injury
bull Used to supplement mortality and morbidity indicators
bull Examples
1 number of days of restricted activity
2 work-loss days (or school-loss days)
Nutritional Status Indicators
bull Anthropometric measurements of preschool children ndash eg weight height mid- arm circumference
bull Heights (and sometimes weights) of children at school entry
bull Prevalence of low birth weight (less than 25 kg)
Health Care Delivery Indicators
bull The frequently used indicators of health care delivery ndash Doctor-population ratio ndash Doctor-nurse ratio ndash Population-bed ratio ndash Population per health center ndash Population per traditional birth attendant
bull These indicators reflect the equity of distribution of
health resources in different parts of the country and of the provision of health care
Utilization rates
bull The extent of use of health services
bull Is expressed as the proportion of people in need of a service who actually receive it in given period usually a year
bull Health care utilization is also affected by factors such as availability and accessibility of health services and the attitude of an individual towards his health and the health care system
Utilization rates
bull Examples of utilization rates
bull proportion of infants who are fully immunized against the 6 EPI diseases
bull proportion of pregnant women who receive antenatal care or have their deliveries supervised by a trained birth attendant
bull bed-occupancy rate (ie average daily in-patient censusaverage number of beds)
bull bed turn-over ration (ie dischargesaverage beds)
Socio-economic Indicators bull These indicators do not directly measure health
But they are of great importance in the interpretation of the indicators of health care ndash rate of population increase ndash per capita GNP ndash level of unemployment ndash dependency ratio ndash literacy rates ndash family size ndash housing the number of persons per room ndash per capita calorie availability
Health Policy Indicators
bull Proportion of GNP spent on health services
bull Proportion of GNP spent on health-related activities (including water supply and sanitation housing and nutrition community development)
bull Proportion of total health resources devoted to primary health care
Who compiles health indicators
bullReports are compiled at every local level - Health departments foundations helliphellip
bullNational ndashgovernmentprivate partnerships
bull International ndash WHO
Data Sources for Common Indicators
bull National Vital Statistics System (Birth Mortality)
bull Census data
bull Surveys (Behavioral Risk Factor Survey--Adults and Youth
National Health Interview Survey National Health and
Nutrition Examination Survey National Survey of Childrens
Health National Immunization Survey)
bull Disease Surveillance Systems
bull Health services administrative data
Health Indicators Part I
Indicators are like a waterhellip Too little of it you die of thirst Too much you drown in it
By Building Health information system able to
generate a list of Essential indicators covering the basic information needs
Keep it straight forward and simple
Global population health and well-being are both determinants and consequences
of major demographic changes
1 Migration within and across countries
2 Women in the paid workforce
3 Decreases in fertility and increase in life expectancy in many countries
So whatrsquos the world going to look like in the next 20-40 yearshellipby 2025 or 2050
Increasingly urban
Increasingly old
Increasingly diverse with migration
Increasing women in workforce
Global trends in longevity
Global Declines in Fertility
Doomsday scenarios
bull Rising inequality
bull Fragile families and communities
bull New urban areas that canrsquot catch up quickly
bull Environmental consequences
bull Social exclusion and ldquodis- integrationrdquo
bull Increased conflict
Global health indicators highlighting the health inequality
Global health indicators are improving
overall in the worldhellip
But not in all places not for all social
groups and not at the same speed
Health inequality
bullThere is a difference between the health status of one population compared to another population or difference between population subgroups
How to measure health inequality
bullMost measurement of health inequality involves the use of indicators to measure health
Health indicators within the Monitoring Evaluation and Review framework
Source Adapted from Monitoring evaluation and review of national health strategies a country-led platform for information and accountability Geneva World Health Organization 2011
INPUTS AND PROCESSES
OUTPUTS OUTCOMES IMPACT
bull Health financing
bull Health workforce
bull Infrastructure bull Information bull Governance
bull Service access and readiness
bull Service quality and safety
bull Coverage of interventions
bull Risk factors and behaviours
bull Health status bull Financial risk
protection bull Responsiveness
Indicators of Health - classification
bull Mortality indicators
bull Morbidity indicators
bull Disability indicators
bull Nutritional status indicators
bull Health care delivery indicators
bull Health care Utilization indicators
bull Indicators of social and mental health
bull Environmental indicators
bull Socio-economic indicators
bull Health policy indicators
bull Other indicators
Mortality Indicators
a Crude death rate
bull It is defined as the number of deaths per 1000 population
per year in a given community
bull Reducing the number of deaths in the population is an obvious goal of medicine and health care and success or failure to do so is a measure of a nations commitment to better health
Crude death rate = _Number of deaths (all causes)___ 1000
Estimated midyear population
Mortality Indicators
bull Age-specific death rate = ____number of deaths (25-44)_____ 1000
estimated midyear population (25-44)
bull Cause-specific death rate = __Number of deaths (specific cause)__ 100000
Estimated midyear population
Mortality Indicators
b Life expectancy
bull ldquoThe average number of years that will be lived by those born alive into a population if the current age-specific mortality rates persistldquo
bull Life expectancy is a good indicator of socio-economic development in general
bull A minimum life expectancy at birth of 60 years is the goal of Health for All by 2000AD
Mortality Indicators
c Infant Mortality rate bull It is the ratio of deaths under 1 year of age in a given year
to the total number of live births in the same year usually expressed as a rate per 1000 live births
bull It is one of the most universally accepted indicators of health status not only of infants but also of whole population and of the socioeconomic conditions under which they live
bull The global strategy of Health for All has suggested an infant mortality rate of not more than 50 per 1000 live births by 2000 AD
Mortality Indicators
d Child Mortality Rate
bull It is defined as the number of deaths at ages 1-4 years in a given year per 1000 children in that age group at the mid-point of the year concerned
e Maternal Mortality Rate
Maternal Mortality rate
bullMaternal deaths death of a woman 1048633 while pregnant or 1048633 within 42 days of termination of pregnancy 1048633 Irrespective of the duration or site of the pregnancy 1048633 From any cause related to or aggravated by the pregnancy or its management 1048633 Not from accidental causes bullNumber of women who die as a result of complications of pregnancy or childbearing in a given year per 1000 live births in that year bullRepresents both the obstetric risk
Morbidity Indicators
bull Mortality indicators do not reveal the burden of ill health in a community
bull The following morbidity rates are used for assessing ill health in the community
ndash Incidence and Prevalence
ndash Attendance rates at out-patient departments health centers etc
ndash Admission Readmission and Discharge rates
ndash Duration of stay in hospital and
Morbidity Indicators
bull Incidence rate = No of new cases of a disease _in a certain time period___ population at risk in same time period No of new and old cases of a disease
bull Prevalence rate = _________in a certain time period________ population at risk in same time period No of new cases in a narrowly defined
bull Attack rate = ______population during a specific time period______ population at risk in same time period
Disability Rates
bull Disability rates related to illness and injury
bull Used to supplement mortality and morbidity indicators
bull Examples
1 number of days of restricted activity
2 work-loss days (or school-loss days)
Nutritional Status Indicators
bull Anthropometric measurements of preschool children ndash eg weight height mid- arm circumference
bull Heights (and sometimes weights) of children at school entry
bull Prevalence of low birth weight (less than 25 kg)
Health Care Delivery Indicators
bull The frequently used indicators of health care delivery ndash Doctor-population ratio ndash Doctor-nurse ratio ndash Population-bed ratio ndash Population per health center ndash Population per traditional birth attendant
bull These indicators reflect the equity of distribution of
health resources in different parts of the country and of the provision of health care
Utilization rates
bull The extent of use of health services
bull Is expressed as the proportion of people in need of a service who actually receive it in given period usually a year
bull Health care utilization is also affected by factors such as availability and accessibility of health services and the attitude of an individual towards his health and the health care system
Utilization rates
bull Examples of utilization rates
bull proportion of infants who are fully immunized against the 6 EPI diseases
bull proportion of pregnant women who receive antenatal care or have their deliveries supervised by a trained birth attendant
bull bed-occupancy rate (ie average daily in-patient censusaverage number of beds)
bull bed turn-over ration (ie dischargesaverage beds)
Socio-economic Indicators bull These indicators do not directly measure health
But they are of great importance in the interpretation of the indicators of health care ndash rate of population increase ndash per capita GNP ndash level of unemployment ndash dependency ratio ndash literacy rates ndash family size ndash housing the number of persons per room ndash per capita calorie availability
Health Policy Indicators
bull Proportion of GNP spent on health services
bull Proportion of GNP spent on health-related activities (including water supply and sanitation housing and nutrition community development)
bull Proportion of total health resources devoted to primary health care
Who compiles health indicators
bullReports are compiled at every local level - Health departments foundations helliphellip
bullNational ndashgovernmentprivate partnerships
bull International ndash WHO
Data Sources for Common Indicators
bull National Vital Statistics System (Birth Mortality)
bull Census data
bull Surveys (Behavioral Risk Factor Survey--Adults and Youth
National Health Interview Survey National Health and
Nutrition Examination Survey National Survey of Childrens
Health National Immunization Survey)
bull Disease Surveillance Systems
bull Health services administrative data
Health Indicators Part I
Indicators are like a waterhellip Too little of it you die of thirst Too much you drown in it
By Building Health information system able to
generate a list of Essential indicators covering the basic information needs
Keep it straight forward and simple
Global population health and well-being are both determinants and consequences
of major demographic changes
1 Migration within and across countries
2 Women in the paid workforce
3 Decreases in fertility and increase in life expectancy in many countries
So whatrsquos the world going to look like in the next 20-40 yearshellipby 2025 or 2050
Increasingly urban
Increasingly old
Increasingly diverse with migration
Increasing women in workforce
Global trends in longevity
Global Declines in Fertility
Doomsday scenarios
bull Rising inequality
bull Fragile families and communities
bull New urban areas that canrsquot catch up quickly
bull Environmental consequences
bull Social exclusion and ldquodis- integrationrdquo
bull Increased conflict
Global health indicators are improving
overall in the worldhellip
But not in all places not for all social
groups and not at the same speed
Health inequality
bullThere is a difference between the health status of one population compared to another population or difference between population subgroups
How to measure health inequality
bullMost measurement of health inequality involves the use of indicators to measure health
Health indicators within the Monitoring Evaluation and Review framework
Source Adapted from Monitoring evaluation and review of national health strategies a country-led platform for information and accountability Geneva World Health Organization 2011
INPUTS AND PROCESSES
OUTPUTS OUTCOMES IMPACT
bull Health financing
bull Health workforce
bull Infrastructure bull Information bull Governance
bull Service access and readiness
bull Service quality and safety
bull Coverage of interventions
bull Risk factors and behaviours
bull Health status bull Financial risk
protection bull Responsiveness
Indicators of Health - classification
bull Mortality indicators
bull Morbidity indicators
bull Disability indicators
bull Nutritional status indicators
bull Health care delivery indicators
bull Health care Utilization indicators
bull Indicators of social and mental health
bull Environmental indicators
bull Socio-economic indicators
bull Health policy indicators
bull Other indicators
Mortality Indicators
a Crude death rate
bull It is defined as the number of deaths per 1000 population
per year in a given community
bull Reducing the number of deaths in the population is an obvious goal of medicine and health care and success or failure to do so is a measure of a nations commitment to better health
Crude death rate = _Number of deaths (all causes)___ 1000
Estimated midyear population
Mortality Indicators
bull Age-specific death rate = ____number of deaths (25-44)_____ 1000
estimated midyear population (25-44)
bull Cause-specific death rate = __Number of deaths (specific cause)__ 100000
Estimated midyear population
Mortality Indicators
b Life expectancy
bull ldquoThe average number of years that will be lived by those born alive into a population if the current age-specific mortality rates persistldquo
bull Life expectancy is a good indicator of socio-economic development in general
bull A minimum life expectancy at birth of 60 years is the goal of Health for All by 2000AD
Mortality Indicators
c Infant Mortality rate bull It is the ratio of deaths under 1 year of age in a given year
to the total number of live births in the same year usually expressed as a rate per 1000 live births
bull It is one of the most universally accepted indicators of health status not only of infants but also of whole population and of the socioeconomic conditions under which they live
bull The global strategy of Health for All has suggested an infant mortality rate of not more than 50 per 1000 live births by 2000 AD
Mortality Indicators
d Child Mortality Rate
bull It is defined as the number of deaths at ages 1-4 years in a given year per 1000 children in that age group at the mid-point of the year concerned
e Maternal Mortality Rate
Maternal Mortality rate
bullMaternal deaths death of a woman 1048633 while pregnant or 1048633 within 42 days of termination of pregnancy 1048633 Irrespective of the duration or site of the pregnancy 1048633 From any cause related to or aggravated by the pregnancy or its management 1048633 Not from accidental causes bullNumber of women who die as a result of complications of pregnancy or childbearing in a given year per 1000 live births in that year bullRepresents both the obstetric risk
Morbidity Indicators
bull Mortality indicators do not reveal the burden of ill health in a community
bull The following morbidity rates are used for assessing ill health in the community
ndash Incidence and Prevalence
ndash Attendance rates at out-patient departments health centers etc
ndash Admission Readmission and Discharge rates
ndash Duration of stay in hospital and
Morbidity Indicators
bull Incidence rate = No of new cases of a disease _in a certain time period___ population at risk in same time period No of new and old cases of a disease
bull Prevalence rate = _________in a certain time period________ population at risk in same time period No of new cases in a narrowly defined
bull Attack rate = ______population during a specific time period______ population at risk in same time period
Disability Rates
bull Disability rates related to illness and injury
bull Used to supplement mortality and morbidity indicators
bull Examples
1 number of days of restricted activity
2 work-loss days (or school-loss days)
Nutritional Status Indicators
bull Anthropometric measurements of preschool children ndash eg weight height mid- arm circumference
bull Heights (and sometimes weights) of children at school entry
bull Prevalence of low birth weight (less than 25 kg)
Health Care Delivery Indicators
bull The frequently used indicators of health care delivery ndash Doctor-population ratio ndash Doctor-nurse ratio ndash Population-bed ratio ndash Population per health center ndash Population per traditional birth attendant
bull These indicators reflect the equity of distribution of
health resources in different parts of the country and of the provision of health care
Utilization rates
bull The extent of use of health services
bull Is expressed as the proportion of people in need of a service who actually receive it in given period usually a year
bull Health care utilization is also affected by factors such as availability and accessibility of health services and the attitude of an individual towards his health and the health care system
Utilization rates
bull Examples of utilization rates
bull proportion of infants who are fully immunized against the 6 EPI diseases
bull proportion of pregnant women who receive antenatal care or have their deliveries supervised by a trained birth attendant
bull bed-occupancy rate (ie average daily in-patient censusaverage number of beds)
bull bed turn-over ration (ie dischargesaverage beds)
Socio-economic Indicators bull These indicators do not directly measure health
But they are of great importance in the interpretation of the indicators of health care ndash rate of population increase ndash per capita GNP ndash level of unemployment ndash dependency ratio ndash literacy rates ndash family size ndash housing the number of persons per room ndash per capita calorie availability
Health Policy Indicators
bull Proportion of GNP spent on health services
bull Proportion of GNP spent on health-related activities (including water supply and sanitation housing and nutrition community development)
bull Proportion of total health resources devoted to primary health care
Who compiles health indicators
bullReports are compiled at every local level - Health departments foundations helliphellip
bullNational ndashgovernmentprivate partnerships
bull International ndash WHO
Data Sources for Common Indicators
bull National Vital Statistics System (Birth Mortality)
bull Census data
bull Surveys (Behavioral Risk Factor Survey--Adults and Youth
National Health Interview Survey National Health and
Nutrition Examination Survey National Survey of Childrens
Health National Immunization Survey)
bull Disease Surveillance Systems
bull Health services administrative data
Health Indicators Part I
Indicators are like a waterhellip Too little of it you die of thirst Too much you drown in it
By Building Health information system able to
generate a list of Essential indicators covering the basic information needs
Keep it straight forward and simple
Global population health and well-being are both determinants and consequences
of major demographic changes
1 Migration within and across countries
2 Women in the paid workforce
3 Decreases in fertility and increase in life expectancy in many countries
So whatrsquos the world going to look like in the next 20-40 yearshellipby 2025 or 2050
Increasingly urban
Increasingly old
Increasingly diverse with migration
Increasing women in workforce
Global trends in longevity
Global Declines in Fertility
Doomsday scenarios
bull Rising inequality
bull Fragile families and communities
bull New urban areas that canrsquot catch up quickly
bull Environmental consequences
bull Social exclusion and ldquodis- integrationrdquo
bull Increased conflict
Health inequality
bullThere is a difference between the health status of one population compared to another population or difference between population subgroups
How to measure health inequality
bullMost measurement of health inequality involves the use of indicators to measure health
Health indicators within the Monitoring Evaluation and Review framework
Source Adapted from Monitoring evaluation and review of national health strategies a country-led platform for information and accountability Geneva World Health Organization 2011
INPUTS AND PROCESSES
OUTPUTS OUTCOMES IMPACT
bull Health financing
bull Health workforce
bull Infrastructure bull Information bull Governance
bull Service access and readiness
bull Service quality and safety
bull Coverage of interventions
bull Risk factors and behaviours
bull Health status bull Financial risk
protection bull Responsiveness
Indicators of Health - classification
bull Mortality indicators
bull Morbidity indicators
bull Disability indicators
bull Nutritional status indicators
bull Health care delivery indicators
bull Health care Utilization indicators
bull Indicators of social and mental health
bull Environmental indicators
bull Socio-economic indicators
bull Health policy indicators
bull Other indicators
Mortality Indicators
a Crude death rate
bull It is defined as the number of deaths per 1000 population
per year in a given community
bull Reducing the number of deaths in the population is an obvious goal of medicine and health care and success or failure to do so is a measure of a nations commitment to better health
Crude death rate = _Number of deaths (all causes)___ 1000
Estimated midyear population
Mortality Indicators
bull Age-specific death rate = ____number of deaths (25-44)_____ 1000
estimated midyear population (25-44)
bull Cause-specific death rate = __Number of deaths (specific cause)__ 100000
Estimated midyear population
Mortality Indicators
b Life expectancy
bull ldquoThe average number of years that will be lived by those born alive into a population if the current age-specific mortality rates persistldquo
bull Life expectancy is a good indicator of socio-economic development in general
bull A minimum life expectancy at birth of 60 years is the goal of Health for All by 2000AD
Mortality Indicators
c Infant Mortality rate bull It is the ratio of deaths under 1 year of age in a given year
to the total number of live births in the same year usually expressed as a rate per 1000 live births
bull It is one of the most universally accepted indicators of health status not only of infants but also of whole population and of the socioeconomic conditions under which they live
bull The global strategy of Health for All has suggested an infant mortality rate of not more than 50 per 1000 live births by 2000 AD
Mortality Indicators
d Child Mortality Rate
bull It is defined as the number of deaths at ages 1-4 years in a given year per 1000 children in that age group at the mid-point of the year concerned
e Maternal Mortality Rate
Maternal Mortality rate
bullMaternal deaths death of a woman 1048633 while pregnant or 1048633 within 42 days of termination of pregnancy 1048633 Irrespective of the duration or site of the pregnancy 1048633 From any cause related to or aggravated by the pregnancy or its management 1048633 Not from accidental causes bullNumber of women who die as a result of complications of pregnancy or childbearing in a given year per 1000 live births in that year bullRepresents both the obstetric risk
Morbidity Indicators
bull Mortality indicators do not reveal the burden of ill health in a community
bull The following morbidity rates are used for assessing ill health in the community
ndash Incidence and Prevalence
ndash Attendance rates at out-patient departments health centers etc
ndash Admission Readmission and Discharge rates
ndash Duration of stay in hospital and
Morbidity Indicators
bull Incidence rate = No of new cases of a disease _in a certain time period___ population at risk in same time period No of new and old cases of a disease
bull Prevalence rate = _________in a certain time period________ population at risk in same time period No of new cases in a narrowly defined
bull Attack rate = ______population during a specific time period______ population at risk in same time period
Disability Rates
bull Disability rates related to illness and injury
bull Used to supplement mortality and morbidity indicators
bull Examples
1 number of days of restricted activity
2 work-loss days (or school-loss days)
Nutritional Status Indicators
bull Anthropometric measurements of preschool children ndash eg weight height mid- arm circumference
bull Heights (and sometimes weights) of children at school entry
bull Prevalence of low birth weight (less than 25 kg)
Health Care Delivery Indicators
bull The frequently used indicators of health care delivery ndash Doctor-population ratio ndash Doctor-nurse ratio ndash Population-bed ratio ndash Population per health center ndash Population per traditional birth attendant
bull These indicators reflect the equity of distribution of
health resources in different parts of the country and of the provision of health care
Utilization rates
bull The extent of use of health services
bull Is expressed as the proportion of people in need of a service who actually receive it in given period usually a year
bull Health care utilization is also affected by factors such as availability and accessibility of health services and the attitude of an individual towards his health and the health care system
Utilization rates
bull Examples of utilization rates
bull proportion of infants who are fully immunized against the 6 EPI diseases
bull proportion of pregnant women who receive antenatal care or have their deliveries supervised by a trained birth attendant
bull bed-occupancy rate (ie average daily in-patient censusaverage number of beds)
bull bed turn-over ration (ie dischargesaverage beds)
Socio-economic Indicators bull These indicators do not directly measure health
But they are of great importance in the interpretation of the indicators of health care ndash rate of population increase ndash per capita GNP ndash level of unemployment ndash dependency ratio ndash literacy rates ndash family size ndash housing the number of persons per room ndash per capita calorie availability
Health Policy Indicators
bull Proportion of GNP spent on health services
bull Proportion of GNP spent on health-related activities (including water supply and sanitation housing and nutrition community development)
bull Proportion of total health resources devoted to primary health care
Who compiles health indicators
bullReports are compiled at every local level - Health departments foundations helliphellip
bullNational ndashgovernmentprivate partnerships
bull International ndash WHO
Data Sources for Common Indicators
bull National Vital Statistics System (Birth Mortality)
bull Census data
bull Surveys (Behavioral Risk Factor Survey--Adults and Youth
National Health Interview Survey National Health and
Nutrition Examination Survey National Survey of Childrens
Health National Immunization Survey)
bull Disease Surveillance Systems
bull Health services administrative data
Health Indicators Part I
Indicators are like a waterhellip Too little of it you die of thirst Too much you drown in it
By Building Health information system able to
generate a list of Essential indicators covering the basic information needs
Keep it straight forward and simple
Global population health and well-being are both determinants and consequences
of major demographic changes
1 Migration within and across countries
2 Women in the paid workforce
3 Decreases in fertility and increase in life expectancy in many countries
So whatrsquos the world going to look like in the next 20-40 yearshellipby 2025 or 2050
Increasingly urban
Increasingly old
Increasingly diverse with migration
Increasing women in workforce
Global trends in longevity
Global Declines in Fertility
Doomsday scenarios
bull Rising inequality
bull Fragile families and communities
bull New urban areas that canrsquot catch up quickly
bull Environmental consequences
bull Social exclusion and ldquodis- integrationrdquo
bull Increased conflict
How to measure health inequality
bullMost measurement of health inequality involves the use of indicators to measure health
Health indicators within the Monitoring Evaluation and Review framework
Source Adapted from Monitoring evaluation and review of national health strategies a country-led platform for information and accountability Geneva World Health Organization 2011
INPUTS AND PROCESSES
OUTPUTS OUTCOMES IMPACT
bull Health financing
bull Health workforce
bull Infrastructure bull Information bull Governance
bull Service access and readiness
bull Service quality and safety
bull Coverage of interventions
bull Risk factors and behaviours
bull Health status bull Financial risk
protection bull Responsiveness
Indicators of Health - classification
bull Mortality indicators
bull Morbidity indicators
bull Disability indicators
bull Nutritional status indicators
bull Health care delivery indicators
bull Health care Utilization indicators
bull Indicators of social and mental health
bull Environmental indicators
bull Socio-economic indicators
bull Health policy indicators
bull Other indicators
Mortality Indicators
a Crude death rate
bull It is defined as the number of deaths per 1000 population
per year in a given community
bull Reducing the number of deaths in the population is an obvious goal of medicine and health care and success or failure to do so is a measure of a nations commitment to better health
Crude death rate = _Number of deaths (all causes)___ 1000
Estimated midyear population
Mortality Indicators
bull Age-specific death rate = ____number of deaths (25-44)_____ 1000
estimated midyear population (25-44)
bull Cause-specific death rate = __Number of deaths (specific cause)__ 100000
Estimated midyear population
Mortality Indicators
b Life expectancy
bull ldquoThe average number of years that will be lived by those born alive into a population if the current age-specific mortality rates persistldquo
bull Life expectancy is a good indicator of socio-economic development in general
bull A minimum life expectancy at birth of 60 years is the goal of Health for All by 2000AD
Mortality Indicators
c Infant Mortality rate bull It is the ratio of deaths under 1 year of age in a given year
to the total number of live births in the same year usually expressed as a rate per 1000 live births
bull It is one of the most universally accepted indicators of health status not only of infants but also of whole population and of the socioeconomic conditions under which they live
bull The global strategy of Health for All has suggested an infant mortality rate of not more than 50 per 1000 live births by 2000 AD
Mortality Indicators
d Child Mortality Rate
bull It is defined as the number of deaths at ages 1-4 years in a given year per 1000 children in that age group at the mid-point of the year concerned
e Maternal Mortality Rate
Maternal Mortality rate
bullMaternal deaths death of a woman 1048633 while pregnant or 1048633 within 42 days of termination of pregnancy 1048633 Irrespective of the duration or site of the pregnancy 1048633 From any cause related to or aggravated by the pregnancy or its management 1048633 Not from accidental causes bullNumber of women who die as a result of complications of pregnancy or childbearing in a given year per 1000 live births in that year bullRepresents both the obstetric risk
Morbidity Indicators
bull Mortality indicators do not reveal the burden of ill health in a community
bull The following morbidity rates are used for assessing ill health in the community
ndash Incidence and Prevalence
ndash Attendance rates at out-patient departments health centers etc
ndash Admission Readmission and Discharge rates
ndash Duration of stay in hospital and
Morbidity Indicators
bull Incidence rate = No of new cases of a disease _in a certain time period___ population at risk in same time period No of new and old cases of a disease
bull Prevalence rate = _________in a certain time period________ population at risk in same time period No of new cases in a narrowly defined
bull Attack rate = ______population during a specific time period______ population at risk in same time period
Disability Rates
bull Disability rates related to illness and injury
bull Used to supplement mortality and morbidity indicators
bull Examples
1 number of days of restricted activity
2 work-loss days (or school-loss days)
Nutritional Status Indicators
bull Anthropometric measurements of preschool children ndash eg weight height mid- arm circumference
bull Heights (and sometimes weights) of children at school entry
bull Prevalence of low birth weight (less than 25 kg)
Health Care Delivery Indicators
bull The frequently used indicators of health care delivery ndash Doctor-population ratio ndash Doctor-nurse ratio ndash Population-bed ratio ndash Population per health center ndash Population per traditional birth attendant
bull These indicators reflect the equity of distribution of
health resources in different parts of the country and of the provision of health care
Utilization rates
bull The extent of use of health services
bull Is expressed as the proportion of people in need of a service who actually receive it in given period usually a year
bull Health care utilization is also affected by factors such as availability and accessibility of health services and the attitude of an individual towards his health and the health care system
Utilization rates
bull Examples of utilization rates
bull proportion of infants who are fully immunized against the 6 EPI diseases
bull proportion of pregnant women who receive antenatal care or have their deliveries supervised by a trained birth attendant
bull bed-occupancy rate (ie average daily in-patient censusaverage number of beds)
bull bed turn-over ration (ie dischargesaverage beds)
Socio-economic Indicators bull These indicators do not directly measure health
But they are of great importance in the interpretation of the indicators of health care ndash rate of population increase ndash per capita GNP ndash level of unemployment ndash dependency ratio ndash literacy rates ndash family size ndash housing the number of persons per room ndash per capita calorie availability
Health Policy Indicators
bull Proportion of GNP spent on health services
bull Proportion of GNP spent on health-related activities (including water supply and sanitation housing and nutrition community development)
bull Proportion of total health resources devoted to primary health care
Who compiles health indicators
bullReports are compiled at every local level - Health departments foundations helliphellip
bullNational ndashgovernmentprivate partnerships
bull International ndash WHO
Data Sources for Common Indicators
bull National Vital Statistics System (Birth Mortality)
bull Census data
bull Surveys (Behavioral Risk Factor Survey--Adults and Youth
National Health Interview Survey National Health and
Nutrition Examination Survey National Survey of Childrens
Health National Immunization Survey)
bull Disease Surveillance Systems
bull Health services administrative data
Health Indicators Part I
Indicators are like a waterhellip Too little of it you die of thirst Too much you drown in it
By Building Health information system able to
generate a list of Essential indicators covering the basic information needs
Keep it straight forward and simple
Global population health and well-being are both determinants and consequences
of major demographic changes
1 Migration within and across countries
2 Women in the paid workforce
3 Decreases in fertility and increase in life expectancy in many countries
So whatrsquos the world going to look like in the next 20-40 yearshellipby 2025 or 2050
Increasingly urban
Increasingly old
Increasingly diverse with migration
Increasing women in workforce
Global trends in longevity
Global Declines in Fertility
Doomsday scenarios
bull Rising inequality
bull Fragile families and communities
bull New urban areas that canrsquot catch up quickly
bull Environmental consequences
bull Social exclusion and ldquodis- integrationrdquo
bull Increased conflict
Health indicators within the Monitoring Evaluation and Review framework
Source Adapted from Monitoring evaluation and review of national health strategies a country-led platform for information and accountability Geneva World Health Organization 2011
INPUTS AND PROCESSES
OUTPUTS OUTCOMES IMPACT
bull Health financing
bull Health workforce
bull Infrastructure bull Information bull Governance
bull Service access and readiness
bull Service quality and safety
bull Coverage of interventions
bull Risk factors and behaviours
bull Health status bull Financial risk
protection bull Responsiveness
Indicators of Health - classification
bull Mortality indicators
bull Morbidity indicators
bull Disability indicators
bull Nutritional status indicators
bull Health care delivery indicators
bull Health care Utilization indicators
bull Indicators of social and mental health
bull Environmental indicators
bull Socio-economic indicators
bull Health policy indicators
bull Other indicators
Mortality Indicators
a Crude death rate
bull It is defined as the number of deaths per 1000 population
per year in a given community
bull Reducing the number of deaths in the population is an obvious goal of medicine and health care and success or failure to do so is a measure of a nations commitment to better health
Crude death rate = _Number of deaths (all causes)___ 1000
Estimated midyear population
Mortality Indicators
bull Age-specific death rate = ____number of deaths (25-44)_____ 1000
estimated midyear population (25-44)
bull Cause-specific death rate = __Number of deaths (specific cause)__ 100000
Estimated midyear population
Mortality Indicators
b Life expectancy
bull ldquoThe average number of years that will be lived by those born alive into a population if the current age-specific mortality rates persistldquo
bull Life expectancy is a good indicator of socio-economic development in general
bull A minimum life expectancy at birth of 60 years is the goal of Health for All by 2000AD
Mortality Indicators
c Infant Mortality rate bull It is the ratio of deaths under 1 year of age in a given year
to the total number of live births in the same year usually expressed as a rate per 1000 live births
bull It is one of the most universally accepted indicators of health status not only of infants but also of whole population and of the socioeconomic conditions under which they live
bull The global strategy of Health for All has suggested an infant mortality rate of not more than 50 per 1000 live births by 2000 AD
Mortality Indicators
d Child Mortality Rate
bull It is defined as the number of deaths at ages 1-4 years in a given year per 1000 children in that age group at the mid-point of the year concerned
e Maternal Mortality Rate
Maternal Mortality rate
bullMaternal deaths death of a woman 1048633 while pregnant or 1048633 within 42 days of termination of pregnancy 1048633 Irrespective of the duration or site of the pregnancy 1048633 From any cause related to or aggravated by the pregnancy or its management 1048633 Not from accidental causes bullNumber of women who die as a result of complications of pregnancy or childbearing in a given year per 1000 live births in that year bullRepresents both the obstetric risk
Morbidity Indicators
bull Mortality indicators do not reveal the burden of ill health in a community
bull The following morbidity rates are used for assessing ill health in the community
ndash Incidence and Prevalence
ndash Attendance rates at out-patient departments health centers etc
ndash Admission Readmission and Discharge rates
ndash Duration of stay in hospital and
Morbidity Indicators
bull Incidence rate = No of new cases of a disease _in a certain time period___ population at risk in same time period No of new and old cases of a disease
bull Prevalence rate = _________in a certain time period________ population at risk in same time period No of new cases in a narrowly defined
bull Attack rate = ______population during a specific time period______ population at risk in same time period
Disability Rates
bull Disability rates related to illness and injury
bull Used to supplement mortality and morbidity indicators
bull Examples
1 number of days of restricted activity
2 work-loss days (or school-loss days)
Nutritional Status Indicators
bull Anthropometric measurements of preschool children ndash eg weight height mid- arm circumference
bull Heights (and sometimes weights) of children at school entry
bull Prevalence of low birth weight (less than 25 kg)
Health Care Delivery Indicators
bull The frequently used indicators of health care delivery ndash Doctor-population ratio ndash Doctor-nurse ratio ndash Population-bed ratio ndash Population per health center ndash Population per traditional birth attendant
bull These indicators reflect the equity of distribution of
health resources in different parts of the country and of the provision of health care
Utilization rates
bull The extent of use of health services
bull Is expressed as the proportion of people in need of a service who actually receive it in given period usually a year
bull Health care utilization is also affected by factors such as availability and accessibility of health services and the attitude of an individual towards his health and the health care system
Utilization rates
bull Examples of utilization rates
bull proportion of infants who are fully immunized against the 6 EPI diseases
bull proportion of pregnant women who receive antenatal care or have their deliveries supervised by a trained birth attendant
bull bed-occupancy rate (ie average daily in-patient censusaverage number of beds)
bull bed turn-over ration (ie dischargesaverage beds)
Socio-economic Indicators bull These indicators do not directly measure health
But they are of great importance in the interpretation of the indicators of health care ndash rate of population increase ndash per capita GNP ndash level of unemployment ndash dependency ratio ndash literacy rates ndash family size ndash housing the number of persons per room ndash per capita calorie availability
Health Policy Indicators
bull Proportion of GNP spent on health services
bull Proportion of GNP spent on health-related activities (including water supply and sanitation housing and nutrition community development)
bull Proportion of total health resources devoted to primary health care
Who compiles health indicators
bullReports are compiled at every local level - Health departments foundations helliphellip
bullNational ndashgovernmentprivate partnerships
bull International ndash WHO
Data Sources for Common Indicators
bull National Vital Statistics System (Birth Mortality)
bull Census data
bull Surveys (Behavioral Risk Factor Survey--Adults and Youth
National Health Interview Survey National Health and
Nutrition Examination Survey National Survey of Childrens
Health National Immunization Survey)
bull Disease Surveillance Systems
bull Health services administrative data
Health Indicators Part I
Indicators are like a waterhellip Too little of it you die of thirst Too much you drown in it
By Building Health information system able to
generate a list of Essential indicators covering the basic information needs
Keep it straight forward and simple
Global population health and well-being are both determinants and consequences
of major demographic changes
1 Migration within and across countries
2 Women in the paid workforce
3 Decreases in fertility and increase in life expectancy in many countries
So whatrsquos the world going to look like in the next 20-40 yearshellipby 2025 or 2050
Increasingly urban
Increasingly old
Increasingly diverse with migration
Increasing women in workforce
Global trends in longevity
Global Declines in Fertility
Doomsday scenarios
bull Rising inequality
bull Fragile families and communities
bull New urban areas that canrsquot catch up quickly
bull Environmental consequences
bull Social exclusion and ldquodis- integrationrdquo
bull Increased conflict
Indicators of Health - classification
bull Mortality indicators
bull Morbidity indicators
bull Disability indicators
bull Nutritional status indicators
bull Health care delivery indicators
bull Health care Utilization indicators
bull Indicators of social and mental health
bull Environmental indicators
bull Socio-economic indicators
bull Health policy indicators
bull Other indicators
Mortality Indicators
a Crude death rate
bull It is defined as the number of deaths per 1000 population
per year in a given community
bull Reducing the number of deaths in the population is an obvious goal of medicine and health care and success or failure to do so is a measure of a nations commitment to better health
Crude death rate = _Number of deaths (all causes)___ 1000
Estimated midyear population
Mortality Indicators
bull Age-specific death rate = ____number of deaths (25-44)_____ 1000
estimated midyear population (25-44)
bull Cause-specific death rate = __Number of deaths (specific cause)__ 100000
Estimated midyear population
Mortality Indicators
b Life expectancy
bull ldquoThe average number of years that will be lived by those born alive into a population if the current age-specific mortality rates persistldquo
bull Life expectancy is a good indicator of socio-economic development in general
bull A minimum life expectancy at birth of 60 years is the goal of Health for All by 2000AD
Mortality Indicators
c Infant Mortality rate bull It is the ratio of deaths under 1 year of age in a given year
to the total number of live births in the same year usually expressed as a rate per 1000 live births
bull It is one of the most universally accepted indicators of health status not only of infants but also of whole population and of the socioeconomic conditions under which they live
bull The global strategy of Health for All has suggested an infant mortality rate of not more than 50 per 1000 live births by 2000 AD
Mortality Indicators
d Child Mortality Rate
bull It is defined as the number of deaths at ages 1-4 years in a given year per 1000 children in that age group at the mid-point of the year concerned
e Maternal Mortality Rate
Maternal Mortality rate
bullMaternal deaths death of a woman 1048633 while pregnant or 1048633 within 42 days of termination of pregnancy 1048633 Irrespective of the duration or site of the pregnancy 1048633 From any cause related to or aggravated by the pregnancy or its management 1048633 Not from accidental causes bullNumber of women who die as a result of complications of pregnancy or childbearing in a given year per 1000 live births in that year bullRepresents both the obstetric risk
Morbidity Indicators
bull Mortality indicators do not reveal the burden of ill health in a community
bull The following morbidity rates are used for assessing ill health in the community
ndash Incidence and Prevalence
ndash Attendance rates at out-patient departments health centers etc
ndash Admission Readmission and Discharge rates
ndash Duration of stay in hospital and
Morbidity Indicators
bull Incidence rate = No of new cases of a disease _in a certain time period___ population at risk in same time period No of new and old cases of a disease
bull Prevalence rate = _________in a certain time period________ population at risk in same time period No of new cases in a narrowly defined
bull Attack rate = ______population during a specific time period______ population at risk in same time period
Disability Rates
bull Disability rates related to illness and injury
bull Used to supplement mortality and morbidity indicators
bull Examples
1 number of days of restricted activity
2 work-loss days (or school-loss days)
Nutritional Status Indicators
bull Anthropometric measurements of preschool children ndash eg weight height mid- arm circumference
bull Heights (and sometimes weights) of children at school entry
bull Prevalence of low birth weight (less than 25 kg)
Health Care Delivery Indicators
bull The frequently used indicators of health care delivery ndash Doctor-population ratio ndash Doctor-nurse ratio ndash Population-bed ratio ndash Population per health center ndash Population per traditional birth attendant
bull These indicators reflect the equity of distribution of
health resources in different parts of the country and of the provision of health care
Utilization rates
bull The extent of use of health services
bull Is expressed as the proportion of people in need of a service who actually receive it in given period usually a year
bull Health care utilization is also affected by factors such as availability and accessibility of health services and the attitude of an individual towards his health and the health care system
Utilization rates
bull Examples of utilization rates
bull proportion of infants who are fully immunized against the 6 EPI diseases
bull proportion of pregnant women who receive antenatal care or have their deliveries supervised by a trained birth attendant
bull bed-occupancy rate (ie average daily in-patient censusaverage number of beds)
bull bed turn-over ration (ie dischargesaverage beds)
Socio-economic Indicators bull These indicators do not directly measure health
But they are of great importance in the interpretation of the indicators of health care ndash rate of population increase ndash per capita GNP ndash level of unemployment ndash dependency ratio ndash literacy rates ndash family size ndash housing the number of persons per room ndash per capita calorie availability
Health Policy Indicators
bull Proportion of GNP spent on health services
bull Proportion of GNP spent on health-related activities (including water supply and sanitation housing and nutrition community development)
bull Proportion of total health resources devoted to primary health care
Who compiles health indicators
bullReports are compiled at every local level - Health departments foundations helliphellip
bullNational ndashgovernmentprivate partnerships
bull International ndash WHO
Data Sources for Common Indicators
bull National Vital Statistics System (Birth Mortality)
bull Census data
bull Surveys (Behavioral Risk Factor Survey--Adults and Youth
National Health Interview Survey National Health and
Nutrition Examination Survey National Survey of Childrens
Health National Immunization Survey)
bull Disease Surveillance Systems
bull Health services administrative data
Health Indicators Part I
Indicators are like a waterhellip Too little of it you die of thirst Too much you drown in it
By Building Health information system able to
generate a list of Essential indicators covering the basic information needs
Keep it straight forward and simple
Global population health and well-being are both determinants and consequences
of major demographic changes
1 Migration within and across countries
2 Women in the paid workforce
3 Decreases in fertility and increase in life expectancy in many countries
So whatrsquos the world going to look like in the next 20-40 yearshellipby 2025 or 2050
Increasingly urban
Increasingly old
Increasingly diverse with migration
Increasing women in workforce
Global trends in longevity
Global Declines in Fertility
Doomsday scenarios
bull Rising inequality
bull Fragile families and communities
bull New urban areas that canrsquot catch up quickly
bull Environmental consequences
bull Social exclusion and ldquodis- integrationrdquo
bull Increased conflict
Mortality Indicators
a Crude death rate
bull It is defined as the number of deaths per 1000 population
per year in a given community
bull Reducing the number of deaths in the population is an obvious goal of medicine and health care and success or failure to do so is a measure of a nations commitment to better health
Crude death rate = _Number of deaths (all causes)___ 1000
Estimated midyear population
Mortality Indicators
bull Age-specific death rate = ____number of deaths (25-44)_____ 1000
estimated midyear population (25-44)
bull Cause-specific death rate = __Number of deaths (specific cause)__ 100000
Estimated midyear population
Mortality Indicators
b Life expectancy
bull ldquoThe average number of years that will be lived by those born alive into a population if the current age-specific mortality rates persistldquo
bull Life expectancy is a good indicator of socio-economic development in general
bull A minimum life expectancy at birth of 60 years is the goal of Health for All by 2000AD
Mortality Indicators
c Infant Mortality rate bull It is the ratio of deaths under 1 year of age in a given year
to the total number of live births in the same year usually expressed as a rate per 1000 live births
bull It is one of the most universally accepted indicators of health status not only of infants but also of whole population and of the socioeconomic conditions under which they live
bull The global strategy of Health for All has suggested an infant mortality rate of not more than 50 per 1000 live births by 2000 AD
Mortality Indicators
d Child Mortality Rate
bull It is defined as the number of deaths at ages 1-4 years in a given year per 1000 children in that age group at the mid-point of the year concerned
e Maternal Mortality Rate
Maternal Mortality rate
bullMaternal deaths death of a woman 1048633 while pregnant or 1048633 within 42 days of termination of pregnancy 1048633 Irrespective of the duration or site of the pregnancy 1048633 From any cause related to or aggravated by the pregnancy or its management 1048633 Not from accidental causes bullNumber of women who die as a result of complications of pregnancy or childbearing in a given year per 1000 live births in that year bullRepresents both the obstetric risk
Morbidity Indicators
bull Mortality indicators do not reveal the burden of ill health in a community
bull The following morbidity rates are used for assessing ill health in the community
ndash Incidence and Prevalence
ndash Attendance rates at out-patient departments health centers etc
ndash Admission Readmission and Discharge rates
ndash Duration of stay in hospital and
Morbidity Indicators
bull Incidence rate = No of new cases of a disease _in a certain time period___ population at risk in same time period No of new and old cases of a disease
bull Prevalence rate = _________in a certain time period________ population at risk in same time period No of new cases in a narrowly defined
bull Attack rate = ______population during a specific time period______ population at risk in same time period
Disability Rates
bull Disability rates related to illness and injury
bull Used to supplement mortality and morbidity indicators
bull Examples
1 number of days of restricted activity
2 work-loss days (or school-loss days)
Nutritional Status Indicators
bull Anthropometric measurements of preschool children ndash eg weight height mid- arm circumference
bull Heights (and sometimes weights) of children at school entry
bull Prevalence of low birth weight (less than 25 kg)
Health Care Delivery Indicators
bull The frequently used indicators of health care delivery ndash Doctor-population ratio ndash Doctor-nurse ratio ndash Population-bed ratio ndash Population per health center ndash Population per traditional birth attendant
bull These indicators reflect the equity of distribution of
health resources in different parts of the country and of the provision of health care
Utilization rates
bull The extent of use of health services
bull Is expressed as the proportion of people in need of a service who actually receive it in given period usually a year
bull Health care utilization is also affected by factors such as availability and accessibility of health services and the attitude of an individual towards his health and the health care system
Utilization rates
bull Examples of utilization rates
bull proportion of infants who are fully immunized against the 6 EPI diseases
bull proportion of pregnant women who receive antenatal care or have their deliveries supervised by a trained birth attendant
bull bed-occupancy rate (ie average daily in-patient censusaverage number of beds)
bull bed turn-over ration (ie dischargesaverage beds)
Socio-economic Indicators bull These indicators do not directly measure health
But they are of great importance in the interpretation of the indicators of health care ndash rate of population increase ndash per capita GNP ndash level of unemployment ndash dependency ratio ndash literacy rates ndash family size ndash housing the number of persons per room ndash per capita calorie availability
Health Policy Indicators
bull Proportion of GNP spent on health services
bull Proportion of GNP spent on health-related activities (including water supply and sanitation housing and nutrition community development)
bull Proportion of total health resources devoted to primary health care
Who compiles health indicators
bullReports are compiled at every local level - Health departments foundations helliphellip
bullNational ndashgovernmentprivate partnerships
bull International ndash WHO
Data Sources for Common Indicators
bull National Vital Statistics System (Birth Mortality)
bull Census data
bull Surveys (Behavioral Risk Factor Survey--Adults and Youth
National Health Interview Survey National Health and
Nutrition Examination Survey National Survey of Childrens
Health National Immunization Survey)
bull Disease Surveillance Systems
bull Health services administrative data
Health Indicators Part I
Indicators are like a waterhellip Too little of it you die of thirst Too much you drown in it
By Building Health information system able to
generate a list of Essential indicators covering the basic information needs
Keep it straight forward and simple
Global population health and well-being are both determinants and consequences
of major demographic changes
1 Migration within and across countries
2 Women in the paid workforce
3 Decreases in fertility and increase in life expectancy in many countries
So whatrsquos the world going to look like in the next 20-40 yearshellipby 2025 or 2050
Increasingly urban
Increasingly old
Increasingly diverse with migration
Increasing women in workforce
Global trends in longevity
Global Declines in Fertility
Doomsday scenarios
bull Rising inequality
bull Fragile families and communities
bull New urban areas that canrsquot catch up quickly
bull Environmental consequences
bull Social exclusion and ldquodis- integrationrdquo
bull Increased conflict
Mortality Indicators
bull Age-specific death rate = ____number of deaths (25-44)_____ 1000
estimated midyear population (25-44)
bull Cause-specific death rate = __Number of deaths (specific cause)__ 100000
Estimated midyear population
Mortality Indicators
b Life expectancy
bull ldquoThe average number of years that will be lived by those born alive into a population if the current age-specific mortality rates persistldquo
bull Life expectancy is a good indicator of socio-economic development in general
bull A minimum life expectancy at birth of 60 years is the goal of Health for All by 2000AD
Mortality Indicators
c Infant Mortality rate bull It is the ratio of deaths under 1 year of age in a given year
to the total number of live births in the same year usually expressed as a rate per 1000 live births
bull It is one of the most universally accepted indicators of health status not only of infants but also of whole population and of the socioeconomic conditions under which they live
bull The global strategy of Health for All has suggested an infant mortality rate of not more than 50 per 1000 live births by 2000 AD
Mortality Indicators
d Child Mortality Rate
bull It is defined as the number of deaths at ages 1-4 years in a given year per 1000 children in that age group at the mid-point of the year concerned
e Maternal Mortality Rate
Maternal Mortality rate
bullMaternal deaths death of a woman 1048633 while pregnant or 1048633 within 42 days of termination of pregnancy 1048633 Irrespective of the duration or site of the pregnancy 1048633 From any cause related to or aggravated by the pregnancy or its management 1048633 Not from accidental causes bullNumber of women who die as a result of complications of pregnancy or childbearing in a given year per 1000 live births in that year bullRepresents both the obstetric risk
Morbidity Indicators
bull Mortality indicators do not reveal the burden of ill health in a community
bull The following morbidity rates are used for assessing ill health in the community
ndash Incidence and Prevalence
ndash Attendance rates at out-patient departments health centers etc
ndash Admission Readmission and Discharge rates
ndash Duration of stay in hospital and
Morbidity Indicators
bull Incidence rate = No of new cases of a disease _in a certain time period___ population at risk in same time period No of new and old cases of a disease
bull Prevalence rate = _________in a certain time period________ population at risk in same time period No of new cases in a narrowly defined
bull Attack rate = ______population during a specific time period______ population at risk in same time period
Disability Rates
bull Disability rates related to illness and injury
bull Used to supplement mortality and morbidity indicators
bull Examples
1 number of days of restricted activity
2 work-loss days (or school-loss days)
Nutritional Status Indicators
bull Anthropometric measurements of preschool children ndash eg weight height mid- arm circumference
bull Heights (and sometimes weights) of children at school entry
bull Prevalence of low birth weight (less than 25 kg)
Health Care Delivery Indicators
bull The frequently used indicators of health care delivery ndash Doctor-population ratio ndash Doctor-nurse ratio ndash Population-bed ratio ndash Population per health center ndash Population per traditional birth attendant
bull These indicators reflect the equity of distribution of
health resources in different parts of the country and of the provision of health care
Utilization rates
bull The extent of use of health services
bull Is expressed as the proportion of people in need of a service who actually receive it in given period usually a year
bull Health care utilization is also affected by factors such as availability and accessibility of health services and the attitude of an individual towards his health and the health care system
Utilization rates
bull Examples of utilization rates
bull proportion of infants who are fully immunized against the 6 EPI diseases
bull proportion of pregnant women who receive antenatal care or have their deliveries supervised by a trained birth attendant
bull bed-occupancy rate (ie average daily in-patient censusaverage number of beds)
bull bed turn-over ration (ie dischargesaverage beds)
Socio-economic Indicators bull These indicators do not directly measure health
But they are of great importance in the interpretation of the indicators of health care ndash rate of population increase ndash per capita GNP ndash level of unemployment ndash dependency ratio ndash literacy rates ndash family size ndash housing the number of persons per room ndash per capita calorie availability
Health Policy Indicators
bull Proportion of GNP spent on health services
bull Proportion of GNP spent on health-related activities (including water supply and sanitation housing and nutrition community development)
bull Proportion of total health resources devoted to primary health care
Who compiles health indicators
bullReports are compiled at every local level - Health departments foundations helliphellip
bullNational ndashgovernmentprivate partnerships
bull International ndash WHO
Data Sources for Common Indicators
bull National Vital Statistics System (Birth Mortality)
bull Census data
bull Surveys (Behavioral Risk Factor Survey--Adults and Youth
National Health Interview Survey National Health and
Nutrition Examination Survey National Survey of Childrens
Health National Immunization Survey)
bull Disease Surveillance Systems
bull Health services administrative data
Health Indicators Part I
Indicators are like a waterhellip Too little of it you die of thirst Too much you drown in it
By Building Health information system able to
generate a list of Essential indicators covering the basic information needs
Keep it straight forward and simple
Global population health and well-being are both determinants and consequences
of major demographic changes
1 Migration within and across countries
2 Women in the paid workforce
3 Decreases in fertility and increase in life expectancy in many countries
So whatrsquos the world going to look like in the next 20-40 yearshellipby 2025 or 2050
Increasingly urban
Increasingly old
Increasingly diverse with migration
Increasing women in workforce
Global trends in longevity
Global Declines in Fertility
Doomsday scenarios
bull Rising inequality
bull Fragile families and communities
bull New urban areas that canrsquot catch up quickly
bull Environmental consequences
bull Social exclusion and ldquodis- integrationrdquo
bull Increased conflict
Mortality Indicators
b Life expectancy
bull ldquoThe average number of years that will be lived by those born alive into a population if the current age-specific mortality rates persistldquo
bull Life expectancy is a good indicator of socio-economic development in general
bull A minimum life expectancy at birth of 60 years is the goal of Health for All by 2000AD
Mortality Indicators
c Infant Mortality rate bull It is the ratio of deaths under 1 year of age in a given year
to the total number of live births in the same year usually expressed as a rate per 1000 live births
bull It is one of the most universally accepted indicators of health status not only of infants but also of whole population and of the socioeconomic conditions under which they live
bull The global strategy of Health for All has suggested an infant mortality rate of not more than 50 per 1000 live births by 2000 AD
Mortality Indicators
d Child Mortality Rate
bull It is defined as the number of deaths at ages 1-4 years in a given year per 1000 children in that age group at the mid-point of the year concerned
e Maternal Mortality Rate
Maternal Mortality rate
bullMaternal deaths death of a woman 1048633 while pregnant or 1048633 within 42 days of termination of pregnancy 1048633 Irrespective of the duration or site of the pregnancy 1048633 From any cause related to or aggravated by the pregnancy or its management 1048633 Not from accidental causes bullNumber of women who die as a result of complications of pregnancy or childbearing in a given year per 1000 live births in that year bullRepresents both the obstetric risk
Morbidity Indicators
bull Mortality indicators do not reveal the burden of ill health in a community
bull The following morbidity rates are used for assessing ill health in the community
ndash Incidence and Prevalence
ndash Attendance rates at out-patient departments health centers etc
ndash Admission Readmission and Discharge rates
ndash Duration of stay in hospital and
Morbidity Indicators
bull Incidence rate = No of new cases of a disease _in a certain time period___ population at risk in same time period No of new and old cases of a disease
bull Prevalence rate = _________in a certain time period________ population at risk in same time period No of new cases in a narrowly defined
bull Attack rate = ______population during a specific time period______ population at risk in same time period
Disability Rates
bull Disability rates related to illness and injury
bull Used to supplement mortality and morbidity indicators
bull Examples
1 number of days of restricted activity
2 work-loss days (or school-loss days)
Nutritional Status Indicators
bull Anthropometric measurements of preschool children ndash eg weight height mid- arm circumference
bull Heights (and sometimes weights) of children at school entry
bull Prevalence of low birth weight (less than 25 kg)
Health Care Delivery Indicators
bull The frequently used indicators of health care delivery ndash Doctor-population ratio ndash Doctor-nurse ratio ndash Population-bed ratio ndash Population per health center ndash Population per traditional birth attendant
bull These indicators reflect the equity of distribution of
health resources in different parts of the country and of the provision of health care
Utilization rates
bull The extent of use of health services
bull Is expressed as the proportion of people in need of a service who actually receive it in given period usually a year
bull Health care utilization is also affected by factors such as availability and accessibility of health services and the attitude of an individual towards his health and the health care system
Utilization rates
bull Examples of utilization rates
bull proportion of infants who are fully immunized against the 6 EPI diseases
bull proportion of pregnant women who receive antenatal care or have their deliveries supervised by a trained birth attendant
bull bed-occupancy rate (ie average daily in-patient censusaverage number of beds)
bull bed turn-over ration (ie dischargesaverage beds)
Socio-economic Indicators bull These indicators do not directly measure health
But they are of great importance in the interpretation of the indicators of health care ndash rate of population increase ndash per capita GNP ndash level of unemployment ndash dependency ratio ndash literacy rates ndash family size ndash housing the number of persons per room ndash per capita calorie availability
Health Policy Indicators
bull Proportion of GNP spent on health services
bull Proportion of GNP spent on health-related activities (including water supply and sanitation housing and nutrition community development)
bull Proportion of total health resources devoted to primary health care
Who compiles health indicators
bullReports are compiled at every local level - Health departments foundations helliphellip
bullNational ndashgovernmentprivate partnerships
bull International ndash WHO
Data Sources for Common Indicators
bull National Vital Statistics System (Birth Mortality)
bull Census data
bull Surveys (Behavioral Risk Factor Survey--Adults and Youth
National Health Interview Survey National Health and
Nutrition Examination Survey National Survey of Childrens
Health National Immunization Survey)
bull Disease Surveillance Systems
bull Health services administrative data
Health Indicators Part I
Indicators are like a waterhellip Too little of it you die of thirst Too much you drown in it
By Building Health information system able to
generate a list of Essential indicators covering the basic information needs
Keep it straight forward and simple
Global population health and well-being are both determinants and consequences
of major demographic changes
1 Migration within and across countries
2 Women in the paid workforce
3 Decreases in fertility and increase in life expectancy in many countries
So whatrsquos the world going to look like in the next 20-40 yearshellipby 2025 or 2050
Increasingly urban
Increasingly old
Increasingly diverse with migration
Increasing women in workforce
Global trends in longevity
Global Declines in Fertility
Doomsday scenarios
bull Rising inequality
bull Fragile families and communities
bull New urban areas that canrsquot catch up quickly
bull Environmental consequences
bull Social exclusion and ldquodis- integrationrdquo
bull Increased conflict
Mortality Indicators
c Infant Mortality rate bull It is the ratio of deaths under 1 year of age in a given year
to the total number of live births in the same year usually expressed as a rate per 1000 live births
bull It is one of the most universally accepted indicators of health status not only of infants but also of whole population and of the socioeconomic conditions under which they live
bull The global strategy of Health for All has suggested an infant mortality rate of not more than 50 per 1000 live births by 2000 AD
Mortality Indicators
d Child Mortality Rate
bull It is defined as the number of deaths at ages 1-4 years in a given year per 1000 children in that age group at the mid-point of the year concerned
e Maternal Mortality Rate
Maternal Mortality rate
bullMaternal deaths death of a woman 1048633 while pregnant or 1048633 within 42 days of termination of pregnancy 1048633 Irrespective of the duration or site of the pregnancy 1048633 From any cause related to or aggravated by the pregnancy or its management 1048633 Not from accidental causes bullNumber of women who die as a result of complications of pregnancy or childbearing in a given year per 1000 live births in that year bullRepresents both the obstetric risk
Morbidity Indicators
bull Mortality indicators do not reveal the burden of ill health in a community
bull The following morbidity rates are used for assessing ill health in the community
ndash Incidence and Prevalence
ndash Attendance rates at out-patient departments health centers etc
ndash Admission Readmission and Discharge rates
ndash Duration of stay in hospital and
Morbidity Indicators
bull Incidence rate = No of new cases of a disease _in a certain time period___ population at risk in same time period No of new and old cases of a disease
bull Prevalence rate = _________in a certain time period________ population at risk in same time period No of new cases in a narrowly defined
bull Attack rate = ______population during a specific time period______ population at risk in same time period
Disability Rates
bull Disability rates related to illness and injury
bull Used to supplement mortality and morbidity indicators
bull Examples
1 number of days of restricted activity
2 work-loss days (or school-loss days)
Nutritional Status Indicators
bull Anthropometric measurements of preschool children ndash eg weight height mid- arm circumference
bull Heights (and sometimes weights) of children at school entry
bull Prevalence of low birth weight (less than 25 kg)
Health Care Delivery Indicators
bull The frequently used indicators of health care delivery ndash Doctor-population ratio ndash Doctor-nurse ratio ndash Population-bed ratio ndash Population per health center ndash Population per traditional birth attendant
bull These indicators reflect the equity of distribution of
health resources in different parts of the country and of the provision of health care
Utilization rates
bull The extent of use of health services
bull Is expressed as the proportion of people in need of a service who actually receive it in given period usually a year
bull Health care utilization is also affected by factors such as availability and accessibility of health services and the attitude of an individual towards his health and the health care system
Utilization rates
bull Examples of utilization rates
bull proportion of infants who are fully immunized against the 6 EPI diseases
bull proportion of pregnant women who receive antenatal care or have their deliveries supervised by a trained birth attendant
bull bed-occupancy rate (ie average daily in-patient censusaverage number of beds)
bull bed turn-over ration (ie dischargesaverage beds)
Socio-economic Indicators bull These indicators do not directly measure health
But they are of great importance in the interpretation of the indicators of health care ndash rate of population increase ndash per capita GNP ndash level of unemployment ndash dependency ratio ndash literacy rates ndash family size ndash housing the number of persons per room ndash per capita calorie availability
Health Policy Indicators
bull Proportion of GNP spent on health services
bull Proportion of GNP spent on health-related activities (including water supply and sanitation housing and nutrition community development)
bull Proportion of total health resources devoted to primary health care
Who compiles health indicators
bullReports are compiled at every local level - Health departments foundations helliphellip
bullNational ndashgovernmentprivate partnerships
bull International ndash WHO
Data Sources for Common Indicators
bull National Vital Statistics System (Birth Mortality)
bull Census data
bull Surveys (Behavioral Risk Factor Survey--Adults and Youth
National Health Interview Survey National Health and
Nutrition Examination Survey National Survey of Childrens
Health National Immunization Survey)
bull Disease Surveillance Systems
bull Health services administrative data
Health Indicators Part I
Indicators are like a waterhellip Too little of it you die of thirst Too much you drown in it
By Building Health information system able to
generate a list of Essential indicators covering the basic information needs
Keep it straight forward and simple
Global population health and well-being are both determinants and consequences
of major demographic changes
1 Migration within and across countries
2 Women in the paid workforce
3 Decreases in fertility and increase in life expectancy in many countries
So whatrsquos the world going to look like in the next 20-40 yearshellipby 2025 or 2050
Increasingly urban
Increasingly old
Increasingly diverse with migration
Increasing women in workforce
Global trends in longevity
Global Declines in Fertility
Doomsday scenarios
bull Rising inequality
bull Fragile families and communities
bull New urban areas that canrsquot catch up quickly
bull Environmental consequences
bull Social exclusion and ldquodis- integrationrdquo
bull Increased conflict
Mortality Indicators
d Child Mortality Rate
bull It is defined as the number of deaths at ages 1-4 years in a given year per 1000 children in that age group at the mid-point of the year concerned
e Maternal Mortality Rate
Maternal Mortality rate
bullMaternal deaths death of a woman 1048633 while pregnant or 1048633 within 42 days of termination of pregnancy 1048633 Irrespective of the duration or site of the pregnancy 1048633 From any cause related to or aggravated by the pregnancy or its management 1048633 Not from accidental causes bullNumber of women who die as a result of complications of pregnancy or childbearing in a given year per 1000 live births in that year bullRepresents both the obstetric risk
Morbidity Indicators
bull Mortality indicators do not reveal the burden of ill health in a community
bull The following morbidity rates are used for assessing ill health in the community
ndash Incidence and Prevalence
ndash Attendance rates at out-patient departments health centers etc
ndash Admission Readmission and Discharge rates
ndash Duration of stay in hospital and
Morbidity Indicators
bull Incidence rate = No of new cases of a disease _in a certain time period___ population at risk in same time period No of new and old cases of a disease
bull Prevalence rate = _________in a certain time period________ population at risk in same time period No of new cases in a narrowly defined
bull Attack rate = ______population during a specific time period______ population at risk in same time period
Disability Rates
bull Disability rates related to illness and injury
bull Used to supplement mortality and morbidity indicators
bull Examples
1 number of days of restricted activity
2 work-loss days (or school-loss days)
Nutritional Status Indicators
bull Anthropometric measurements of preschool children ndash eg weight height mid- arm circumference
bull Heights (and sometimes weights) of children at school entry
bull Prevalence of low birth weight (less than 25 kg)
Health Care Delivery Indicators
bull The frequently used indicators of health care delivery ndash Doctor-population ratio ndash Doctor-nurse ratio ndash Population-bed ratio ndash Population per health center ndash Population per traditional birth attendant
bull These indicators reflect the equity of distribution of
health resources in different parts of the country and of the provision of health care
Utilization rates
bull The extent of use of health services
bull Is expressed as the proportion of people in need of a service who actually receive it in given period usually a year
bull Health care utilization is also affected by factors such as availability and accessibility of health services and the attitude of an individual towards his health and the health care system
Utilization rates
bull Examples of utilization rates
bull proportion of infants who are fully immunized against the 6 EPI diseases
bull proportion of pregnant women who receive antenatal care or have their deliveries supervised by a trained birth attendant
bull bed-occupancy rate (ie average daily in-patient censusaverage number of beds)
bull bed turn-over ration (ie dischargesaverage beds)
Socio-economic Indicators bull These indicators do not directly measure health
But they are of great importance in the interpretation of the indicators of health care ndash rate of population increase ndash per capita GNP ndash level of unemployment ndash dependency ratio ndash literacy rates ndash family size ndash housing the number of persons per room ndash per capita calorie availability
Health Policy Indicators
bull Proportion of GNP spent on health services
bull Proportion of GNP spent on health-related activities (including water supply and sanitation housing and nutrition community development)
bull Proportion of total health resources devoted to primary health care
Who compiles health indicators
bullReports are compiled at every local level - Health departments foundations helliphellip
bullNational ndashgovernmentprivate partnerships
bull International ndash WHO
Data Sources for Common Indicators
bull National Vital Statistics System (Birth Mortality)
bull Census data
bull Surveys (Behavioral Risk Factor Survey--Adults and Youth
National Health Interview Survey National Health and
Nutrition Examination Survey National Survey of Childrens
Health National Immunization Survey)
bull Disease Surveillance Systems
bull Health services administrative data
Health Indicators Part I
Indicators are like a waterhellip Too little of it you die of thirst Too much you drown in it
By Building Health information system able to
generate a list of Essential indicators covering the basic information needs
Keep it straight forward and simple
Global population health and well-being are both determinants and consequences
of major demographic changes
1 Migration within and across countries
2 Women in the paid workforce
3 Decreases in fertility and increase in life expectancy in many countries
So whatrsquos the world going to look like in the next 20-40 yearshellipby 2025 or 2050
Increasingly urban
Increasingly old
Increasingly diverse with migration
Increasing women in workforce
Global trends in longevity
Global Declines in Fertility
Doomsday scenarios
bull Rising inequality
bull Fragile families and communities
bull New urban areas that canrsquot catch up quickly
bull Environmental consequences
bull Social exclusion and ldquodis- integrationrdquo
bull Increased conflict
Maternal Mortality rate
bullMaternal deaths death of a woman 1048633 while pregnant or 1048633 within 42 days of termination of pregnancy 1048633 Irrespective of the duration or site of the pregnancy 1048633 From any cause related to or aggravated by the pregnancy or its management 1048633 Not from accidental causes bullNumber of women who die as a result of complications of pregnancy or childbearing in a given year per 1000 live births in that year bullRepresents both the obstetric risk
Morbidity Indicators
bull Mortality indicators do not reveal the burden of ill health in a community
bull The following morbidity rates are used for assessing ill health in the community
ndash Incidence and Prevalence
ndash Attendance rates at out-patient departments health centers etc
ndash Admission Readmission and Discharge rates
ndash Duration of stay in hospital and
Morbidity Indicators
bull Incidence rate = No of new cases of a disease _in a certain time period___ population at risk in same time period No of new and old cases of a disease
bull Prevalence rate = _________in a certain time period________ population at risk in same time period No of new cases in a narrowly defined
bull Attack rate = ______population during a specific time period______ population at risk in same time period
Disability Rates
bull Disability rates related to illness and injury
bull Used to supplement mortality and morbidity indicators
bull Examples
1 number of days of restricted activity
2 work-loss days (or school-loss days)
Nutritional Status Indicators
bull Anthropometric measurements of preschool children ndash eg weight height mid- arm circumference
bull Heights (and sometimes weights) of children at school entry
bull Prevalence of low birth weight (less than 25 kg)
Health Care Delivery Indicators
bull The frequently used indicators of health care delivery ndash Doctor-population ratio ndash Doctor-nurse ratio ndash Population-bed ratio ndash Population per health center ndash Population per traditional birth attendant
bull These indicators reflect the equity of distribution of
health resources in different parts of the country and of the provision of health care
Utilization rates
bull The extent of use of health services
bull Is expressed as the proportion of people in need of a service who actually receive it in given period usually a year
bull Health care utilization is also affected by factors such as availability and accessibility of health services and the attitude of an individual towards his health and the health care system
Utilization rates
bull Examples of utilization rates
bull proportion of infants who are fully immunized against the 6 EPI diseases
bull proportion of pregnant women who receive antenatal care or have their deliveries supervised by a trained birth attendant
bull bed-occupancy rate (ie average daily in-patient censusaverage number of beds)
bull bed turn-over ration (ie dischargesaverage beds)
Socio-economic Indicators bull These indicators do not directly measure health
But they are of great importance in the interpretation of the indicators of health care ndash rate of population increase ndash per capita GNP ndash level of unemployment ndash dependency ratio ndash literacy rates ndash family size ndash housing the number of persons per room ndash per capita calorie availability
Health Policy Indicators
bull Proportion of GNP spent on health services
bull Proportion of GNP spent on health-related activities (including water supply and sanitation housing and nutrition community development)
bull Proportion of total health resources devoted to primary health care
Who compiles health indicators
bullReports are compiled at every local level - Health departments foundations helliphellip
bullNational ndashgovernmentprivate partnerships
bull International ndash WHO
Data Sources for Common Indicators
bull National Vital Statistics System (Birth Mortality)
bull Census data
bull Surveys (Behavioral Risk Factor Survey--Adults and Youth
National Health Interview Survey National Health and
Nutrition Examination Survey National Survey of Childrens
Health National Immunization Survey)
bull Disease Surveillance Systems
bull Health services administrative data
Health Indicators Part I
Indicators are like a waterhellip Too little of it you die of thirst Too much you drown in it
By Building Health information system able to
generate a list of Essential indicators covering the basic information needs
Keep it straight forward and simple
Global population health and well-being are both determinants and consequences
of major demographic changes
1 Migration within and across countries
2 Women in the paid workforce
3 Decreases in fertility and increase in life expectancy in many countries
So whatrsquos the world going to look like in the next 20-40 yearshellipby 2025 or 2050
Increasingly urban
Increasingly old
Increasingly diverse with migration
Increasing women in workforce
Global trends in longevity
Global Declines in Fertility
Doomsday scenarios
bull Rising inequality
bull Fragile families and communities
bull New urban areas that canrsquot catch up quickly
bull Environmental consequences
bull Social exclusion and ldquodis- integrationrdquo
bull Increased conflict
Morbidity Indicators
bull Mortality indicators do not reveal the burden of ill health in a community
bull The following morbidity rates are used for assessing ill health in the community
ndash Incidence and Prevalence
ndash Attendance rates at out-patient departments health centers etc
ndash Admission Readmission and Discharge rates
ndash Duration of stay in hospital and
Morbidity Indicators
bull Incidence rate = No of new cases of a disease _in a certain time period___ population at risk in same time period No of new and old cases of a disease
bull Prevalence rate = _________in a certain time period________ population at risk in same time period No of new cases in a narrowly defined
bull Attack rate = ______population during a specific time period______ population at risk in same time period
Disability Rates
bull Disability rates related to illness and injury
bull Used to supplement mortality and morbidity indicators
bull Examples
1 number of days of restricted activity
2 work-loss days (or school-loss days)
Nutritional Status Indicators
bull Anthropometric measurements of preschool children ndash eg weight height mid- arm circumference
bull Heights (and sometimes weights) of children at school entry
bull Prevalence of low birth weight (less than 25 kg)
Health Care Delivery Indicators
bull The frequently used indicators of health care delivery ndash Doctor-population ratio ndash Doctor-nurse ratio ndash Population-bed ratio ndash Population per health center ndash Population per traditional birth attendant
bull These indicators reflect the equity of distribution of
health resources in different parts of the country and of the provision of health care
Utilization rates
bull The extent of use of health services
bull Is expressed as the proportion of people in need of a service who actually receive it in given period usually a year
bull Health care utilization is also affected by factors such as availability and accessibility of health services and the attitude of an individual towards his health and the health care system
Utilization rates
bull Examples of utilization rates
bull proportion of infants who are fully immunized against the 6 EPI diseases
bull proportion of pregnant women who receive antenatal care or have their deliveries supervised by a trained birth attendant
bull bed-occupancy rate (ie average daily in-patient censusaverage number of beds)
bull bed turn-over ration (ie dischargesaverage beds)
Socio-economic Indicators bull These indicators do not directly measure health
But they are of great importance in the interpretation of the indicators of health care ndash rate of population increase ndash per capita GNP ndash level of unemployment ndash dependency ratio ndash literacy rates ndash family size ndash housing the number of persons per room ndash per capita calorie availability
Health Policy Indicators
bull Proportion of GNP spent on health services
bull Proportion of GNP spent on health-related activities (including water supply and sanitation housing and nutrition community development)
bull Proportion of total health resources devoted to primary health care
Who compiles health indicators
bullReports are compiled at every local level - Health departments foundations helliphellip
bullNational ndashgovernmentprivate partnerships
bull International ndash WHO
Data Sources for Common Indicators
bull National Vital Statistics System (Birth Mortality)
bull Census data
bull Surveys (Behavioral Risk Factor Survey--Adults and Youth
National Health Interview Survey National Health and
Nutrition Examination Survey National Survey of Childrens
Health National Immunization Survey)
bull Disease Surveillance Systems
bull Health services administrative data
Health Indicators Part I
Indicators are like a waterhellip Too little of it you die of thirst Too much you drown in it
By Building Health information system able to
generate a list of Essential indicators covering the basic information needs
Keep it straight forward and simple
Global population health and well-being are both determinants and consequences
of major demographic changes
1 Migration within and across countries
2 Women in the paid workforce
3 Decreases in fertility and increase in life expectancy in many countries
So whatrsquos the world going to look like in the next 20-40 yearshellipby 2025 or 2050
Increasingly urban
Increasingly old
Increasingly diverse with migration
Increasing women in workforce
Global trends in longevity
Global Declines in Fertility
Doomsday scenarios
bull Rising inequality
bull Fragile families and communities
bull New urban areas that canrsquot catch up quickly
bull Environmental consequences
bull Social exclusion and ldquodis- integrationrdquo
bull Increased conflict
Morbidity Indicators
bull Incidence rate = No of new cases of a disease _in a certain time period___ population at risk in same time period No of new and old cases of a disease
bull Prevalence rate = _________in a certain time period________ population at risk in same time period No of new cases in a narrowly defined
bull Attack rate = ______population during a specific time period______ population at risk in same time period
Disability Rates
bull Disability rates related to illness and injury
bull Used to supplement mortality and morbidity indicators
bull Examples
1 number of days of restricted activity
2 work-loss days (or school-loss days)
Nutritional Status Indicators
bull Anthropometric measurements of preschool children ndash eg weight height mid- arm circumference
bull Heights (and sometimes weights) of children at school entry
bull Prevalence of low birth weight (less than 25 kg)
Health Care Delivery Indicators
bull The frequently used indicators of health care delivery ndash Doctor-population ratio ndash Doctor-nurse ratio ndash Population-bed ratio ndash Population per health center ndash Population per traditional birth attendant
bull These indicators reflect the equity of distribution of
health resources in different parts of the country and of the provision of health care
Utilization rates
bull The extent of use of health services
bull Is expressed as the proportion of people in need of a service who actually receive it in given period usually a year
bull Health care utilization is also affected by factors such as availability and accessibility of health services and the attitude of an individual towards his health and the health care system
Utilization rates
bull Examples of utilization rates
bull proportion of infants who are fully immunized against the 6 EPI diseases
bull proportion of pregnant women who receive antenatal care or have their deliveries supervised by a trained birth attendant
bull bed-occupancy rate (ie average daily in-patient censusaverage number of beds)
bull bed turn-over ration (ie dischargesaverage beds)
Socio-economic Indicators bull These indicators do not directly measure health
But they are of great importance in the interpretation of the indicators of health care ndash rate of population increase ndash per capita GNP ndash level of unemployment ndash dependency ratio ndash literacy rates ndash family size ndash housing the number of persons per room ndash per capita calorie availability
Health Policy Indicators
bull Proportion of GNP spent on health services
bull Proportion of GNP spent on health-related activities (including water supply and sanitation housing and nutrition community development)
bull Proportion of total health resources devoted to primary health care
Who compiles health indicators
bullReports are compiled at every local level - Health departments foundations helliphellip
bullNational ndashgovernmentprivate partnerships
bull International ndash WHO
Data Sources for Common Indicators
bull National Vital Statistics System (Birth Mortality)
bull Census data
bull Surveys (Behavioral Risk Factor Survey--Adults and Youth
National Health Interview Survey National Health and
Nutrition Examination Survey National Survey of Childrens
Health National Immunization Survey)
bull Disease Surveillance Systems
bull Health services administrative data
Health Indicators Part I
Indicators are like a waterhellip Too little of it you die of thirst Too much you drown in it
By Building Health information system able to
generate a list of Essential indicators covering the basic information needs
Keep it straight forward and simple
Global population health and well-being are both determinants and consequences
of major demographic changes
1 Migration within and across countries
2 Women in the paid workforce
3 Decreases in fertility and increase in life expectancy in many countries
So whatrsquos the world going to look like in the next 20-40 yearshellipby 2025 or 2050
Increasingly urban
Increasingly old
Increasingly diverse with migration
Increasing women in workforce
Global trends in longevity
Global Declines in Fertility
Doomsday scenarios
bull Rising inequality
bull Fragile families and communities
bull New urban areas that canrsquot catch up quickly
bull Environmental consequences
bull Social exclusion and ldquodis- integrationrdquo
bull Increased conflict
Disability Rates
bull Disability rates related to illness and injury
bull Used to supplement mortality and morbidity indicators
bull Examples
1 number of days of restricted activity
2 work-loss days (or school-loss days)
Nutritional Status Indicators
bull Anthropometric measurements of preschool children ndash eg weight height mid- arm circumference
bull Heights (and sometimes weights) of children at school entry
bull Prevalence of low birth weight (less than 25 kg)
Health Care Delivery Indicators
bull The frequently used indicators of health care delivery ndash Doctor-population ratio ndash Doctor-nurse ratio ndash Population-bed ratio ndash Population per health center ndash Population per traditional birth attendant
bull These indicators reflect the equity of distribution of
health resources in different parts of the country and of the provision of health care
Utilization rates
bull The extent of use of health services
bull Is expressed as the proportion of people in need of a service who actually receive it in given period usually a year
bull Health care utilization is also affected by factors such as availability and accessibility of health services and the attitude of an individual towards his health and the health care system
Utilization rates
bull Examples of utilization rates
bull proportion of infants who are fully immunized against the 6 EPI diseases
bull proportion of pregnant women who receive antenatal care or have their deliveries supervised by a trained birth attendant
bull bed-occupancy rate (ie average daily in-patient censusaverage number of beds)
bull bed turn-over ration (ie dischargesaverage beds)
Socio-economic Indicators bull These indicators do not directly measure health
But they are of great importance in the interpretation of the indicators of health care ndash rate of population increase ndash per capita GNP ndash level of unemployment ndash dependency ratio ndash literacy rates ndash family size ndash housing the number of persons per room ndash per capita calorie availability
Health Policy Indicators
bull Proportion of GNP spent on health services
bull Proportion of GNP spent on health-related activities (including water supply and sanitation housing and nutrition community development)
bull Proportion of total health resources devoted to primary health care
Who compiles health indicators
bullReports are compiled at every local level - Health departments foundations helliphellip
bullNational ndashgovernmentprivate partnerships
bull International ndash WHO
Data Sources for Common Indicators
bull National Vital Statistics System (Birth Mortality)
bull Census data
bull Surveys (Behavioral Risk Factor Survey--Adults and Youth
National Health Interview Survey National Health and
Nutrition Examination Survey National Survey of Childrens
Health National Immunization Survey)
bull Disease Surveillance Systems
bull Health services administrative data
Health Indicators Part I
Indicators are like a waterhellip Too little of it you die of thirst Too much you drown in it
By Building Health information system able to
generate a list of Essential indicators covering the basic information needs
Keep it straight forward and simple
Global population health and well-being are both determinants and consequences
of major demographic changes
1 Migration within and across countries
2 Women in the paid workforce
3 Decreases in fertility and increase in life expectancy in many countries
So whatrsquos the world going to look like in the next 20-40 yearshellipby 2025 or 2050
Increasingly urban
Increasingly old
Increasingly diverse with migration
Increasing women in workforce
Global trends in longevity
Global Declines in Fertility
Doomsday scenarios
bull Rising inequality
bull Fragile families and communities
bull New urban areas that canrsquot catch up quickly
bull Environmental consequences
bull Social exclusion and ldquodis- integrationrdquo
bull Increased conflict
Nutritional Status Indicators
bull Anthropometric measurements of preschool children ndash eg weight height mid- arm circumference
bull Heights (and sometimes weights) of children at school entry
bull Prevalence of low birth weight (less than 25 kg)
Health Care Delivery Indicators
bull The frequently used indicators of health care delivery ndash Doctor-population ratio ndash Doctor-nurse ratio ndash Population-bed ratio ndash Population per health center ndash Population per traditional birth attendant
bull These indicators reflect the equity of distribution of
health resources in different parts of the country and of the provision of health care
Utilization rates
bull The extent of use of health services
bull Is expressed as the proportion of people in need of a service who actually receive it in given period usually a year
bull Health care utilization is also affected by factors such as availability and accessibility of health services and the attitude of an individual towards his health and the health care system
Utilization rates
bull Examples of utilization rates
bull proportion of infants who are fully immunized against the 6 EPI diseases
bull proportion of pregnant women who receive antenatal care or have their deliveries supervised by a trained birth attendant
bull bed-occupancy rate (ie average daily in-patient censusaverage number of beds)
bull bed turn-over ration (ie dischargesaverage beds)
Socio-economic Indicators bull These indicators do not directly measure health
But they are of great importance in the interpretation of the indicators of health care ndash rate of population increase ndash per capita GNP ndash level of unemployment ndash dependency ratio ndash literacy rates ndash family size ndash housing the number of persons per room ndash per capita calorie availability
Health Policy Indicators
bull Proportion of GNP spent on health services
bull Proportion of GNP spent on health-related activities (including water supply and sanitation housing and nutrition community development)
bull Proportion of total health resources devoted to primary health care
Who compiles health indicators
bullReports are compiled at every local level - Health departments foundations helliphellip
bullNational ndashgovernmentprivate partnerships
bull International ndash WHO
Data Sources for Common Indicators
bull National Vital Statistics System (Birth Mortality)
bull Census data
bull Surveys (Behavioral Risk Factor Survey--Adults and Youth
National Health Interview Survey National Health and
Nutrition Examination Survey National Survey of Childrens
Health National Immunization Survey)
bull Disease Surveillance Systems
bull Health services administrative data
Health Indicators Part I
Indicators are like a waterhellip Too little of it you die of thirst Too much you drown in it
By Building Health information system able to
generate a list of Essential indicators covering the basic information needs
Keep it straight forward and simple
Global population health and well-being are both determinants and consequences
of major demographic changes
1 Migration within and across countries
2 Women in the paid workforce
3 Decreases in fertility and increase in life expectancy in many countries
So whatrsquos the world going to look like in the next 20-40 yearshellipby 2025 or 2050
Increasingly urban
Increasingly old
Increasingly diverse with migration
Increasing women in workforce
Global trends in longevity
Global Declines in Fertility
Doomsday scenarios
bull Rising inequality
bull Fragile families and communities
bull New urban areas that canrsquot catch up quickly
bull Environmental consequences
bull Social exclusion and ldquodis- integrationrdquo
bull Increased conflict
Health Care Delivery Indicators
bull The frequently used indicators of health care delivery ndash Doctor-population ratio ndash Doctor-nurse ratio ndash Population-bed ratio ndash Population per health center ndash Population per traditional birth attendant
bull These indicators reflect the equity of distribution of
health resources in different parts of the country and of the provision of health care
Utilization rates
bull The extent of use of health services
bull Is expressed as the proportion of people in need of a service who actually receive it in given period usually a year
bull Health care utilization is also affected by factors such as availability and accessibility of health services and the attitude of an individual towards his health and the health care system
Utilization rates
bull Examples of utilization rates
bull proportion of infants who are fully immunized against the 6 EPI diseases
bull proportion of pregnant women who receive antenatal care or have their deliveries supervised by a trained birth attendant
bull bed-occupancy rate (ie average daily in-patient censusaverage number of beds)
bull bed turn-over ration (ie dischargesaverage beds)
Socio-economic Indicators bull These indicators do not directly measure health
But they are of great importance in the interpretation of the indicators of health care ndash rate of population increase ndash per capita GNP ndash level of unemployment ndash dependency ratio ndash literacy rates ndash family size ndash housing the number of persons per room ndash per capita calorie availability
Health Policy Indicators
bull Proportion of GNP spent on health services
bull Proportion of GNP spent on health-related activities (including water supply and sanitation housing and nutrition community development)
bull Proportion of total health resources devoted to primary health care
Who compiles health indicators
bullReports are compiled at every local level - Health departments foundations helliphellip
bullNational ndashgovernmentprivate partnerships
bull International ndash WHO
Data Sources for Common Indicators
bull National Vital Statistics System (Birth Mortality)
bull Census data
bull Surveys (Behavioral Risk Factor Survey--Adults and Youth
National Health Interview Survey National Health and
Nutrition Examination Survey National Survey of Childrens
Health National Immunization Survey)
bull Disease Surveillance Systems
bull Health services administrative data
Health Indicators Part I
Indicators are like a waterhellip Too little of it you die of thirst Too much you drown in it
By Building Health information system able to
generate a list of Essential indicators covering the basic information needs
Keep it straight forward and simple
Global population health and well-being are both determinants and consequences
of major demographic changes
1 Migration within and across countries
2 Women in the paid workforce
3 Decreases in fertility and increase in life expectancy in many countries
So whatrsquos the world going to look like in the next 20-40 yearshellipby 2025 or 2050
Increasingly urban
Increasingly old
Increasingly diverse with migration
Increasing women in workforce
Global trends in longevity
Global Declines in Fertility
Doomsday scenarios
bull Rising inequality
bull Fragile families and communities
bull New urban areas that canrsquot catch up quickly
bull Environmental consequences
bull Social exclusion and ldquodis- integrationrdquo
bull Increased conflict
Utilization rates
bull The extent of use of health services
bull Is expressed as the proportion of people in need of a service who actually receive it in given period usually a year
bull Health care utilization is also affected by factors such as availability and accessibility of health services and the attitude of an individual towards his health and the health care system
Utilization rates
bull Examples of utilization rates
bull proportion of infants who are fully immunized against the 6 EPI diseases
bull proportion of pregnant women who receive antenatal care or have their deliveries supervised by a trained birth attendant
bull bed-occupancy rate (ie average daily in-patient censusaverage number of beds)
bull bed turn-over ration (ie dischargesaverage beds)
Socio-economic Indicators bull These indicators do not directly measure health
But they are of great importance in the interpretation of the indicators of health care ndash rate of population increase ndash per capita GNP ndash level of unemployment ndash dependency ratio ndash literacy rates ndash family size ndash housing the number of persons per room ndash per capita calorie availability
Health Policy Indicators
bull Proportion of GNP spent on health services
bull Proportion of GNP spent on health-related activities (including water supply and sanitation housing and nutrition community development)
bull Proportion of total health resources devoted to primary health care
Who compiles health indicators
bullReports are compiled at every local level - Health departments foundations helliphellip
bullNational ndashgovernmentprivate partnerships
bull International ndash WHO
Data Sources for Common Indicators
bull National Vital Statistics System (Birth Mortality)
bull Census data
bull Surveys (Behavioral Risk Factor Survey--Adults and Youth
National Health Interview Survey National Health and
Nutrition Examination Survey National Survey of Childrens
Health National Immunization Survey)
bull Disease Surveillance Systems
bull Health services administrative data
Health Indicators Part I
Indicators are like a waterhellip Too little of it you die of thirst Too much you drown in it
By Building Health information system able to
generate a list of Essential indicators covering the basic information needs
Keep it straight forward and simple
Global population health and well-being are both determinants and consequences
of major demographic changes
1 Migration within and across countries
2 Women in the paid workforce
3 Decreases in fertility and increase in life expectancy in many countries
So whatrsquos the world going to look like in the next 20-40 yearshellipby 2025 or 2050
Increasingly urban
Increasingly old
Increasingly diverse with migration
Increasing women in workforce
Global trends in longevity
Global Declines in Fertility
Doomsday scenarios
bull Rising inequality
bull Fragile families and communities
bull New urban areas that canrsquot catch up quickly
bull Environmental consequences
bull Social exclusion and ldquodis- integrationrdquo
bull Increased conflict
Utilization rates
bull Examples of utilization rates
bull proportion of infants who are fully immunized against the 6 EPI diseases
bull proportion of pregnant women who receive antenatal care or have their deliveries supervised by a trained birth attendant
bull bed-occupancy rate (ie average daily in-patient censusaverage number of beds)
bull bed turn-over ration (ie dischargesaverage beds)
Socio-economic Indicators bull These indicators do not directly measure health
But they are of great importance in the interpretation of the indicators of health care ndash rate of population increase ndash per capita GNP ndash level of unemployment ndash dependency ratio ndash literacy rates ndash family size ndash housing the number of persons per room ndash per capita calorie availability
Health Policy Indicators
bull Proportion of GNP spent on health services
bull Proportion of GNP spent on health-related activities (including water supply and sanitation housing and nutrition community development)
bull Proportion of total health resources devoted to primary health care
Who compiles health indicators
bullReports are compiled at every local level - Health departments foundations helliphellip
bullNational ndashgovernmentprivate partnerships
bull International ndash WHO
Data Sources for Common Indicators
bull National Vital Statistics System (Birth Mortality)
bull Census data
bull Surveys (Behavioral Risk Factor Survey--Adults and Youth
National Health Interview Survey National Health and
Nutrition Examination Survey National Survey of Childrens
Health National Immunization Survey)
bull Disease Surveillance Systems
bull Health services administrative data
Health Indicators Part I
Indicators are like a waterhellip Too little of it you die of thirst Too much you drown in it
By Building Health information system able to
generate a list of Essential indicators covering the basic information needs
Keep it straight forward and simple
Global population health and well-being are both determinants and consequences
of major demographic changes
1 Migration within and across countries
2 Women in the paid workforce
3 Decreases in fertility and increase in life expectancy in many countries
So whatrsquos the world going to look like in the next 20-40 yearshellipby 2025 or 2050
Increasingly urban
Increasingly old
Increasingly diverse with migration
Increasing women in workforce
Global trends in longevity
Global Declines in Fertility
Doomsday scenarios
bull Rising inequality
bull Fragile families and communities
bull New urban areas that canrsquot catch up quickly
bull Environmental consequences
bull Social exclusion and ldquodis- integrationrdquo
bull Increased conflict
Socio-economic Indicators bull These indicators do not directly measure health
But they are of great importance in the interpretation of the indicators of health care ndash rate of population increase ndash per capita GNP ndash level of unemployment ndash dependency ratio ndash literacy rates ndash family size ndash housing the number of persons per room ndash per capita calorie availability
Health Policy Indicators
bull Proportion of GNP spent on health services
bull Proportion of GNP spent on health-related activities (including water supply and sanitation housing and nutrition community development)
bull Proportion of total health resources devoted to primary health care
Who compiles health indicators
bullReports are compiled at every local level - Health departments foundations helliphellip
bullNational ndashgovernmentprivate partnerships
bull International ndash WHO
Data Sources for Common Indicators
bull National Vital Statistics System (Birth Mortality)
bull Census data
bull Surveys (Behavioral Risk Factor Survey--Adults and Youth
National Health Interview Survey National Health and
Nutrition Examination Survey National Survey of Childrens
Health National Immunization Survey)
bull Disease Surveillance Systems
bull Health services administrative data
Health Indicators Part I
Indicators are like a waterhellip Too little of it you die of thirst Too much you drown in it
By Building Health information system able to
generate a list of Essential indicators covering the basic information needs
Keep it straight forward and simple
Global population health and well-being are both determinants and consequences
of major demographic changes
1 Migration within and across countries
2 Women in the paid workforce
3 Decreases in fertility and increase in life expectancy in many countries
So whatrsquos the world going to look like in the next 20-40 yearshellipby 2025 or 2050
Increasingly urban
Increasingly old
Increasingly diverse with migration
Increasing women in workforce
Global trends in longevity
Global Declines in Fertility
Doomsday scenarios
bull Rising inequality
bull Fragile families and communities
bull New urban areas that canrsquot catch up quickly
bull Environmental consequences
bull Social exclusion and ldquodis- integrationrdquo
bull Increased conflict
Health Policy Indicators
bull Proportion of GNP spent on health services
bull Proportion of GNP spent on health-related activities (including water supply and sanitation housing and nutrition community development)
bull Proportion of total health resources devoted to primary health care
Who compiles health indicators
bullReports are compiled at every local level - Health departments foundations helliphellip
bullNational ndashgovernmentprivate partnerships
bull International ndash WHO
Data Sources for Common Indicators
bull National Vital Statistics System (Birth Mortality)
bull Census data
bull Surveys (Behavioral Risk Factor Survey--Adults and Youth
National Health Interview Survey National Health and
Nutrition Examination Survey National Survey of Childrens
Health National Immunization Survey)
bull Disease Surveillance Systems
bull Health services administrative data
Health Indicators Part I
Indicators are like a waterhellip Too little of it you die of thirst Too much you drown in it
By Building Health information system able to
generate a list of Essential indicators covering the basic information needs
Keep it straight forward and simple
Global population health and well-being are both determinants and consequences
of major demographic changes
1 Migration within and across countries
2 Women in the paid workforce
3 Decreases in fertility and increase in life expectancy in many countries
So whatrsquos the world going to look like in the next 20-40 yearshellipby 2025 or 2050
Increasingly urban
Increasingly old
Increasingly diverse with migration
Increasing women in workforce
Global trends in longevity
Global Declines in Fertility
Doomsday scenarios
bull Rising inequality
bull Fragile families and communities
bull New urban areas that canrsquot catch up quickly
bull Environmental consequences
bull Social exclusion and ldquodis- integrationrdquo
bull Increased conflict
Who compiles health indicators
bullReports are compiled at every local level - Health departments foundations helliphellip
bullNational ndashgovernmentprivate partnerships
bull International ndash WHO
Data Sources for Common Indicators
bull National Vital Statistics System (Birth Mortality)
bull Census data
bull Surveys (Behavioral Risk Factor Survey--Adults and Youth
National Health Interview Survey National Health and
Nutrition Examination Survey National Survey of Childrens
Health National Immunization Survey)
bull Disease Surveillance Systems
bull Health services administrative data
Health Indicators Part I
Indicators are like a waterhellip Too little of it you die of thirst Too much you drown in it
By Building Health information system able to
generate a list of Essential indicators covering the basic information needs
Keep it straight forward and simple
Global population health and well-being are both determinants and consequences
of major demographic changes
1 Migration within and across countries
2 Women in the paid workforce
3 Decreases in fertility and increase in life expectancy in many countries
So whatrsquos the world going to look like in the next 20-40 yearshellipby 2025 or 2050
Increasingly urban
Increasingly old
Increasingly diverse with migration
Increasing women in workforce
Global trends in longevity
Global Declines in Fertility
Doomsday scenarios
bull Rising inequality
bull Fragile families and communities
bull New urban areas that canrsquot catch up quickly
bull Environmental consequences
bull Social exclusion and ldquodis- integrationrdquo
bull Increased conflict
Data Sources for Common Indicators
bull National Vital Statistics System (Birth Mortality)
bull Census data
bull Surveys (Behavioral Risk Factor Survey--Adults and Youth
National Health Interview Survey National Health and
Nutrition Examination Survey National Survey of Childrens
Health National Immunization Survey)
bull Disease Surveillance Systems
bull Health services administrative data
Health Indicators Part I
Indicators are like a waterhellip Too little of it you die of thirst Too much you drown in it
By Building Health information system able to
generate a list of Essential indicators covering the basic information needs
Keep it straight forward and simple
Global population health and well-being are both determinants and consequences
of major demographic changes
1 Migration within and across countries
2 Women in the paid workforce
3 Decreases in fertility and increase in life expectancy in many countries
So whatrsquos the world going to look like in the next 20-40 yearshellipby 2025 or 2050
Increasingly urban
Increasingly old
Increasingly diverse with migration
Increasing women in workforce
Global trends in longevity
Global Declines in Fertility
Doomsday scenarios
bull Rising inequality
bull Fragile families and communities
bull New urban areas that canrsquot catch up quickly
bull Environmental consequences
bull Social exclusion and ldquodis- integrationrdquo
bull Increased conflict
Indicators are like a waterhellip Too little of it you die of thirst Too much you drown in it
By Building Health information system able to
generate a list of Essential indicators covering the basic information needs
Keep it straight forward and simple
Global population health and well-being are both determinants and consequences
of major demographic changes
1 Migration within and across countries
2 Women in the paid workforce
3 Decreases in fertility and increase in life expectancy in many countries
So whatrsquos the world going to look like in the next 20-40 yearshellipby 2025 or 2050
Increasingly urban
Increasingly old
Increasingly diverse with migration
Increasing women in workforce
Global trends in longevity
Global Declines in Fertility
Doomsday scenarios
bull Rising inequality
bull Fragile families and communities
bull New urban areas that canrsquot catch up quickly
bull Environmental consequences
bull Social exclusion and ldquodis- integrationrdquo
bull Increased conflict
Global population health and well-being are both determinants and consequences
of major demographic changes
1 Migration within and across countries
2 Women in the paid workforce
3 Decreases in fertility and increase in life expectancy in many countries
So whatrsquos the world going to look like in the next 20-40 yearshellipby 2025 or 2050
Increasingly urban
Increasingly old
Increasingly diverse with migration
Increasing women in workforce
Global trends in longevity
Global Declines in Fertility
Doomsday scenarios
bull Rising inequality
bull Fragile families and communities
bull New urban areas that canrsquot catch up quickly
bull Environmental consequences
bull Social exclusion and ldquodis- integrationrdquo
bull Increased conflict
So whatrsquos the world going to look like in the next 20-40 yearshellipby 2025 or 2050
Increasingly urban
Increasingly old
Increasingly diverse with migration
Increasing women in workforce
Global trends in longevity
Global Declines in Fertility
Doomsday scenarios
bull Rising inequality
bull Fragile families and communities
bull New urban areas that canrsquot catch up quickly
bull Environmental consequences
bull Social exclusion and ldquodis- integrationrdquo
bull Increased conflict
Global trends in longevity
Global Declines in Fertility
Doomsday scenarios
bull Rising inequality
bull Fragile families and communities
bull New urban areas that canrsquot catch up quickly
bull Environmental consequences
bull Social exclusion and ldquodis- integrationrdquo
bull Increased conflict
Global Declines in Fertility
Doomsday scenarios
bull Rising inequality
bull Fragile families and communities
bull New urban areas that canrsquot catch up quickly
bull Environmental consequences
bull Social exclusion and ldquodis- integrationrdquo
bull Increased conflict
Doomsday scenarios
bull Rising inequality
bull Fragile families and communities
bull New urban areas that canrsquot catch up quickly
bull Environmental consequences
bull Social exclusion and ldquodis- integrationrdquo
bull Increased conflict