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Concepts of health
- 2. Definition of health • The widely accepted definition of health is that given by World Health Organisation (1948) which is as follows: • “Health is a state of complete physical, mental and social well being and not merely an absence of disease or infirmity”
- 3. Indicators of Health • They are defined as variables which helps to measure the health status of the country USES: 1. To measure the health status of a country 2. To compare the health status of one country with that of another country 3. To assess the health care needs 4. To plan and implement health care services 5. To evaluate the health care services
- 4. Characteristics of indicators 1. Should be valid 2. Should be reliable and objective 3. Should be sensitive 4. Should be specific 5. Should be feasible 6. Should be relevant
- 5. Classification of indicators • Mortality Indicators • Morbidity indicators • Disability rates • Nutritional status indicators • Health care delivery indicators • Utilisation rates • Indicators of social and mental health • Environmental indicators • Socioeconomic indicators • Health policy indicators • Indicators of quality of life • Other indicators
- 6. Mortality Indicators Crude death rate:It is defined as number of deaths per 1000 population in a given community. Reducing the number of deaths in the population is an obvious goal of medicine and health care.A decrease in the death rate provides a good tool for assessing the overall health improvement in a population Expectancy of life:”the average number of years that will be lived by those who born alive into a population if the current age specific mortality rates persist” • At birth – influenced by infant mortality rate • At age 1- excludes the influence of infant mortality rate • At age 5 –excludes the influence of child mortality An increase in the life expectancy is regarded as an improvement in health status and is a good indicator of socioeconomic development in general
- 7. Age- specific death rate:It is defined as total number of deaths occurring in a specific age group of the population in a defined area during a specific period per 1000 estimtaed total population of the same age group of the population in the same area during the same period Infant mortality rate:It is the ratio of deaths under 1year 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 Child death rate:It is defined as the number of deaths at ages 1 to 4 years in agiven year per 1000 children in that age group at the mid point of the year concerned. Under 5 proportional mortality rate:It is the proportion of total deaths occurring in the under 5 age group Adult mortality rate: It is the probability of dying between the age of 15 and 60 years per 1000 population.
- 8. Maternal mortality rate: It accounts for the greatest proportion of deaths among women of reproductive age in most of the developing world . Number of maternal deaths during a given time period per 1000 women of reproductive age during the same period Disease specific mortality rate: Mortality rates can be computed for specific diseases. Deaths from cancer, cardiovascular disease, accident, diabetes, etc., have emerged as measure of specific disease problems Proportional mortality rate: It is the simplest way to estimate the burden of disease in the community.For example: coronary heart disease is the cause of 25 to 30 percent of all deaths in most Western countries Case fatality rate:It measures the risk of person dying from a certain disease within a given time period. It is calculated as number of deaths from specific disease during specific period divided by number of cases of the disease during a same period, usually expressed as per 100 Years of potential life lost:It is defined as one that occurs before the age to which a dying person could have expected to survive.
- 9. Morbidity indicators • These reveal the burden of diseases in a community and hence they are used to supplement the mortality rates USES: For assessing 1. Incidence rate 2. Prevalence rate 3. Notification rate 4. Out patient attendance rate 5. Hospital admission and discharge rate 6. Duration of stay in hospital 7. Spells of sickness or absence from work or school
- 10. Disability Rates • It is the percentage of population unable to perform the routine expected, daily activities due to injury or illness • It is used to supplement the mortality and morbidity indicators • It is divided into two groups Event type indicators. Person type indicators 1. Number of days restricted activity. Limitation of mobility 2. Bed disability days. Limitation of Daily activity 3. Work loss days. Sullivan’s Index:It is computed by subtracting the duration of bed disability from the expectation of life at birth
- 11. • Health Adjusted Life Expectancy(HALE): It is the number of years of a newborn expected to live in full health based on current morbidity and mortality. It was previously termed as DALE • Quality adjusted life years(QALY):It is a measure of disease burden including both the quality and quantity of life lived. 1 QALY is a year of life lived in a perfect health • Disability free life expectancy:It is the average number of years an individual is expected to live free of disability if current pattern of mortality and disability continue to apply • Disability adjusted life years (DALY): It is the number of years lost in a healthy life of an individual due to disability. One DALY is one lost year of healthy life.It is a measure of burden of disease in adefined population and the effectiveness of the interventions
- 12. Nutritional status indicator • It is a positive health indicator • They are 1. Anthropometric measurements of pre school children( weight, height and midarm circumference) 2. Heights of Children at school entry 3. Prevalence of low birth weight
- 13. Health care delivery indicator • This indicates the availability of health man power resources of the country and the provision of health care 1. Doctor-population ratio 2. Doctor-nurse ratio 3. Population-bed ratio 4. Population per health/subcentre 5. Population per trained birth attendant
- 14. Utilization Rates • It is the proportion of the people actually utilizing the health care services in a given population during a given year • Few examples 1. Proportion of infants who are “ fully immunised” 2. Proportion of pregnant women who receive antenatal care 3. Proportion of deliveries supervised by a trained birth attendant 4. Bed occupancy rate 5. Percentage of population using the various methods of family planning
- 15. Indicators of social and mental health It includes • Suicide, homicide,other acts of violence • Road traffic accident • Juvenile delinquency • Alcohol and drug abuse • Smoking • Obesity • Family violence • Battered baby syndrome • Neglected & abandoned youth
- 16. Environmental indicators • These reflect the quality of physical and biological environment • It include the indicators relating to pollution of air,water, noise, radiation,solid waste etc., • Eg: percentage having access to safe drinking water, sanitation facilities, distance from a water standpoint or protected well
- 17. Socioeconomic indicators • It do not directly measure health • These include: 1. Rate of population increase 2. Per capita GNP 3. Level of unemployment 4. Dependency ratio 5. Literacy rate 6. Family size 7. Housing 8. Per capita “calorie” availability
- 18. Health policy indicators • Proportion of GNP spent on health services • Proportion of GNP spent on health related activities ( water supply, sanitation, housing, nutrition, community development) • Proportion of total health resources devoted to primary health care
- 19. Indicators of quality of life • The physical quality of life index is one such index • It consolidates 3 indicators 1. Infant mortality 2. Life expectancy at age one 3. Literacy
- 20. Social Indicators • As defined by the United Nations Statistical Office it has been divided into 12 categories 1. Population, family formation,families and households 2. Learning and educational services 3. Earning activities 4. Distribution of income, consumption and accumulation 5. Social security and welfare services 6. Health services 7. Housing & it’s environment 8. Public order and safety 9. Time use 10. Leisure and culture 11. Social stratification 12. Mobility
- 21. Other indicators • Basic needs performance ( calorie consumption, assess to water,life expectancy, illiteracy…) • “Health for all” inindicators • Millinnium development goal indicator • Sustainable development goals • Global reference list of core health indicators
- 22. Physical quality of life index • Physical quality of life index is a composite index from a number of health indicators • It consolidates three indicators 1. Infant mortality 2. Life expectancy at age one 3. Literacy • These 3 components measure the results rather than inputs • The composite index is calculated by averaging the three indicators giving equal weight to each of them. • The resulting PQLI thus also is scaled 0 to 100
- 23. For example: • Oil rich counties of middle East high per capita income have not very high PQLI • Sri Lanka and Kerala have high PQLI • Thus It does not measure economic growth • It measures the results of social, economic and political policies