isrropucrioy INDICATORS OF HEALTH * Health status indicators measure different INDICATORS OF HEALTH aspects of the health of a population. Examples include life expectancy, infant mortality, disability or chronic disease rates. * Health determinant indicators measure things that influence health. Examples include diet, smoking, water quality, income and access to health services ° Be Dees leae -CHARACTERISTICS + Valid - they should actually measure what they are supposed to measure, ble ~ the results should be the same when measured by different people in similar cireumst they should be sensitive to changes in the n concerned, hey should reflect changes only in the jon concerned. = they should have the ability to obtain data when needed. + Relevant ~ they should contribute to the understanding ‘ of the phenomenon of interest inces. a De seteae aaa ew meU OF INDICATORS OF HEALTH + Measurement of the health of the community. + Description of the health of the community. + Comparison of the health of different communitics, + Identification of health needs and prioritizing them, © * Evaluation of health + Planning and allo * Measurement of health successes. ervices., jon of health resources, Dial eaeCLASSIFICATION OF INDICATORS * Mortality Indicators orn * Morbidity Indicators * Disability Rates * Nutritional Indicators * Health Care Delivery Indicators * Utilization Rates CLASSIFICATION com) wan @osereaoCLASSIFICATION (contd.) * Indicators of Social And Mental Health * Environmental Indicators * Socio-economic Indicators * Health Policy Indicators = Indicators of Quality of Life * Other Indicators ao ee ees aonb[CLASSIFICATION con) MORTALITY INDEICATORS + CRUDE DEATH RATE-It is considered a fair indicator of the comparative health of people. + It is defined as the number of deaths per 1000 population per year in a given community, usually the mid year population * The usefulness is restricted because it is influenced by the age cared sex composition of the population, socioeconomic and socio cultural environment of the communities + CDR of India -6.0 per 1000 population (SRS 2020) isha -7.3 per 1000 population |~ MORTALITY INDICATORS | + Expectation of life isthe average number of years that will be lived by those born alive into a population ifthe current age specific mortality rates persist. + Iisa statistical abstraction based on existing age specific death rates Estimated for both sexes separately. + Good indicator for socioeconomic development. + Life expec birth + Male -68.68 years world bank data 2020 + Female-71.2 years | ae Woe eeeMORTALITY INDICATORS, MORTALITY INDICATORS INFANT MORTALITY RATE + The ratio of deaths under 1 year of age in a given year to the total number of live births in the same yearstisually expressed asa rate per 1000 live births, + Indicator of health status of not only infants but also whole population and socioeconomic conditions. + Sensitive indicator of availability , utilisation and effectiveness of health care , particularly perinatal and postnatal care. * Current IMR —India-28/1000 Live birth ~|_(SRS 2020) Odisha-36/1000 live birth _| Beseiene+ CHILD MORTALITY RATE + 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. + Correlates with inadequate MCH services , malnutrition, low immunisation coverage and environmental factors. + Current rate- 25/1000(NFHSS) + Other indicators are perinatal mortality rate , neonatal mortality rate, still birth rate ete.MORTALITY INDICATORS * UNDER 5 MORTALITY RATE- Defined as no of deaths MORTALITY INDICATORS oceurring in the under $ age group per 1000 live births * Reflects both infant and child mortality + Current rate- + India- 42 per 1000 live birth + NFHS- 5 * Odisha-41.1 Per 1000 live birth = me gisetesMORTALITY INDICATORS + Maternal mortality ratio + Ratio of number of deaths arising during pregnaney or puerperal period per 100000 live births + Accounts for greatest number of deaths reproductive age in developing countries. + Current MMR: India-97 per 100000 live birth b (SRS 2020) Odisha -136 per 100000 live birth mong women of = we Diseiess <0 Tee uakt!MoRRUDETY INDICATORS MORTALITY INDICATORS Disease Specific Death Rate is mortality rate which is computed for specific diseases. Proportional Mortality Rate is the proportion of all deaths attributed to the specific disease E.g. Coronary heart disease causes 25 to 30 % of all deaths in developed world. hivecleaeMORBIDITY INDICATORS + Morbidity Indicators reveal the burden of ill health in a community, but do not measure the subclinical or inapparent disease states. Incidence and Prevalence + Incidence- The number of new events or new cases of a disease in a defined population, within a specified period of time. + Eg. The incidence of Tuberculosis in India is 188 per 100000 ‘MoRRDETY INDICATORS, ae DeeoreMORBIDITY INDICATORS * Prevalence * The total number of all individuals who have an attribute or disease at a particular time divided by population at risk of having attribute or disease at this point of time + Reflects the chronicity of the disease in India is 9.3% (2018-2023) + Eg. The prevalence of diabetes oF Te Desert eneMORBIDITY INDICATORS + Calculated from the reportings to public authorities of certain diseases e.g. yellow fever , poliomyelitis + They provide information regarding geographic clustering of infections, quality of reporting system ete. + Eg-Aw al OPDs and at health centers. Admission, Re-admission and discharge rates dance ratDISABILITY RATES CSullivan’s Index refers to “expectation of life free of disability”. + Sullivan's Index = life expectancy of the country -probable duration of bed disability and inability to perform major activities. + Itis considered as one of the most advanced indicators currently availableDISABILITY RATES QHALE is Health Adjusted Life Expectancy. + Based on the framework of WHO’s ICIDH (International Classification of Impairments, Disabilities, and Handicaps ) + Based on life expectancy at birth but includes an adjustment for time spent in poor health * It is the equivalent number of years in full health that a newborn can expect to live based DENBY RATES on current rates of ill-health and mortality. 2 Ble nL eeleae .DISABILITY RATES QDALYs: Disability Adjusted Life Years. * It is defined as the number of years of healthy life lost due to all causes whether from premature mortality or disability. + It is the simplest and the most commonly used measure to find the burden of illness in a defined population and the effectiveness of the interventions on mre oa e AT om atDISABILITY RATES + Two things needed to measure DALYs are - Life table of that country, to measure the losses from premature deaths. = Loss of healthy life years resulting from disability; the disability may be permanent (polio) ot temporary (TB, leprosy), physical or mental. * DALY = years of life lost + years lost to disability i . a SSuiiesisDISABILITY RATES — * QALY is Quality Adjusted Life Year. * Itis the most commonly used to measure the cost effectiveness of health interventions . + Itestimates the number of years of life added by a successful treatment or adjustment for | quality of life. + Each year in perfect health is assigned a value of 1.0 down to a value of 0.0 for death.eee Seem NUTRITIONAL STATUS INDICATORS Q Nutritional Status is a positive health indicator. G Newborns are measured for their i. Birth weight ii, Length — iii. Head circumference © They reflect the maternal nutrition status O Anthropemetric measurements of pre-school children i. Weight ~ measures acute malnutrition Height ~ measures chronic malnutrition Mid-arm circumference - measures chronic malnutritionNUTRITIONAL STATUS, INDICATORS Underweight: weight for age < -2 standard deviations (SD) of the WHO Child Growth Standards median Stunting: height for age <~2 SD of the WHO Child Growth Standards median Wasting: weight for height <—2 SD of the WHO Child Growth Standards median Overweight: weight for height > +2 SD of the WHO Child Growth Standards medianINDICATORS OF SOCIAL AND MENTAL HEALTH + These include rates of suicide, homicide, other crime, road traffic accident, juvenile delinquency, alcohol and substance abuse, domestic violence, battered-baby syndrome, ete. + These indicators provide a guide to social action for improving the health of people. * Social and mental health of the children depend ‘on their parents. + E.g. Substance abuse in orphan childrenENVIRONMENTAL INDICATORS These reflect the quality of physical and biological environment in which diseases occur and people live. The most important are those measuring the proportion of population having access to safe drinking water and sanitation facilities. These indicators explains the prevalence of communicable diseases in a community. The other indicators are those measuring the pollution of air and water, radiation, noise pollution, exposure to toxic substances in food and water.SOCIOECONOMIC INDICATORS. + These do not directly measure health but are important in interpreting health indicators * These are~ * Rate of growth of population; India- decadal(2001-2011)- 17.64%, Odisha (2001-2011)-10.44% * Per capita GNI( Gross national income) -2390 USD in 2022HEALTH POLICY INDICATORS Ahe single most important indicator of political commitment is allocation of adequate resources. OThe relevant indicators are * Proportion of GNP(gross national product) spent on health services. + Proportion of GNP spent on health related activities like water supply and sanitation & housing and nutrition, + Proportion of total health resources devoted to primary health care. |INDICATORS OF QUALITY OF LIFE OLife expectancy is now less important. O The Quality of Life has gained its importance. Physical Quality of Life Index + It consolidates infant mortality, life expectancy at age of Lyrand literacy. + For each component the performance of individual country is placed on a scale of | to 100. + The composite index is calculated by averaging the three indicators giving equal weight to each of them. ‘+ The result is placed on the 0 to 100 scale. + The PQLI does not consider the GNP. PQL of India stands at 89.56 according to 2020 data,INDICATORS OF QUALITY OF LIFE HUMAN DEVELOPMENT INDEX * Itis defined as composite index combining indicators representing 3 dimensions- 1. Longevity ( life expectancy at birth) 2. Education ( mean and expected year of schooling) 3. Gross national income( GNI) per capita The result is placed on the 0-1 scale HDI for India was 0.644 (UNDP 2022) Ranking 134/193OTHER INDICATORS - Health For All Indicators For monitoring the progress towards the goal of Health For All by 2000 , the WHO had listed the following four categories of indicators. Health policy indicators Political commitment to HFA Resource allocation Degree of equity of distribution of health services Community involvement Organisational framework and managerial processOTHER INDICATORS * Social and economic indicators related to health + Rate of population growth + Income distribution + Work conditions + Adult literacy rate + Housing + Food availability + Indicators for the provision of health care + Availability + Accessibility