Question

List and explain at least two indicators that are commonly used to measure health.

Answer 1

Health indicators

Indicators are required to assess the health of a community and also to compare the health status of one community with the other. Also they are required to monitor and evaluate the success of health services and health programmes.

Characteristics of indicators

An ideal health indicator should be valid, reliable, sensitive and specific.

Valid: it must measure what it is supposed to measure.

Reliable: the answer should be the same if measured by different people.

Sensitive: they should show variations in different situations.

4. Specific: Changes must occur only in the situation concerned.

Types of indicators

A number of indicators are used for the assessment of health. The important indicators of health are:

I.

Mortality indicators

2.

morbidity indicators

3.

disability rates

4.

nutritional status indicators

5.

health care delivery indicators

6.

environmental indicators

7. social and mental health indicators

8. utilization rates

9. socio - economic indicators

10. Others

1. Mortality indicators:

Frequency of death (death rate) is an important indicator of health in a community. Of the various mortality rates, crude death rate is the frequently used index. It is calculated by the following formula:

Crude death rate = Number of deaths in a year ^ Mid-year population The other death rates used are infant mortality rate, child mortality rate, maternal mortality rate, proportional mortality rate and disease specific mortality rate.

2. Morbidity indicators:

The occurrence of disease is also an indicator of health. The various morbidity indicators are incidence rate, prevalence rate, notification rate, hospital attendance, admission and discharge rate etc.

Morbidity can be described using the following frequency measurements: hospital discharge rate, attack/incidence rate, prevalence and case fatality. In CVD, attack rates generally include first and recurrent events, while incidence rates represent only first event. The importance of these measures differs according to the disease as well as the age range. In younger age groups the most important indicators are incidence, case fatality and prevalence; in older people, attack rate and prevalence are more important since patients with chronic diseases require more continuous therapy and rehabilitation, and have a greater impact on the public health system. For acute events, incidence rates are in general target measures, while for chronic conditions incidence as well as prevalence may be of interest. Incidence is used mostly for etiological research objectives; attack rate and prevalence are useful for hospital planning and for primary care. Standardised rates are important to make cross-group comparisons and to investigate time trends, although absolute numbers are often necessary to evaluate the burden of the disease.

3. Disability rates:

These include days of restricted activity, bed disability days and work loss days.

4 Nutritional status indicators:

Personal biological factors

i) prevalence of hypertension: number of persons with systolic blood pressure or diastolic blood

pressure equal to or greater than 140/90 mmHg or undergoing specific treatment divided by

the total population. Blood pressure measurements should be obtained calculating the

meaning of at least two consecutive readings ;

ii) proportion of hypertensives under control: number of hypertensives undergoing specific

treatment with systolic blood pressure or diastolic blood pressure equal to or lower than

140/90 mmHg divided by the total number of hypertensives ;

iii) prevalence of hypercholesterolemia: number of persons with serum total cholesterol equal to

or greater than 193 mg/dl or 5.0 mmol/l or undergoing specific treatment divided by the total

population. Hypercholesterolemia should be determined from at least two consecutive tests ;

iv) prevalence of overweight: number of persons with body mass index equal to or greater than

25 kg/m2 and lower than 30 kg/m2 divided by the total population ;

v) prevalence of obesity: number of persons with body mass index equal to or greater than 30

kg/m2 divided by the total population

They are measurements of height, weight and mid-arm circumference.

5. Health care delivery indicators:

They are a doctor-population ratio, doctor - nurse ratio, population - bed ratio

etc.

6. Environmental indicators:

They include proportion of the population who get safe water, and also indicators relating to pollution of air, light and water.

7. Social and mental health indicators:

Suicides, homicides, smoking, alcoholism and drug abuse.

8. Utilisation rates:

Percentage of immunised children and mothers, bed occupancy rate, length of hospital stay, percentage of people using family planning methods etc.

9. Socio -

Economic indicators: Rate of population increase, literacy rate, family size, housing etc.