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Measure Community Health Status

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IsaacLalrawngbawla1

This document discusses health indicators and how they are used to measure and assess community health status. It provides classifications and examples of different types of indicators including: mortality indicators like infant mortality rate; morbidity indicators; disability rates; nutritional status indicators; and more. The characteristics of valid, reliable, and relevant indicators are also covered. Specific indicators discussed in detail include crude death rate, life expectancy, and indicators for measuring malnutrition prevalence.

Health & Medicine
1 of 63
Health Indicators
How healthy is a given community?
Content Introduction Characteristics of indicator Classification Indicators of health Special Indicators Series Summary
Introduction Indicators are defined as variables which help to measure changes HEALTH INDICATORS 4 Measure health status Compare health status Assess health care needs Allocation of scarce resources Monitoring & evaluation Health indicators are required to: Indicators help to measure the extent to which the objectives and targets of a programme are being attained
Characteristics of indicators β€’ Valid β€’ Reliable β€’ Sensitive β€’ Specific β€’ Feasible β€’ Relevant HEALTH INDICATORS 5
Classification of indicators HEALTH INDICATORS 6 1. Mortality indicators 2. Morbidity indicators 3. Disability rates 4. Nutritional status indicators 5. Health care delivery indicators 6. Utilization rates 7. Indicators of social and mental health 8. Environmental indicators 9. Socio-economic indicators 10.Health policy indicators 11.Indicators of quality of life 12.Other indicators
Mortality indicators 1. Crude death rate 2. Expectation of life 3. Age-specific death rates 4. Infant mortality rate 5. Child death rate HEALTH INDICATORS 7
6. Under-5 proportionate mortality rate 7. Adult mortality rate 8. Maternal mortality rate 9. Disease-specific mortality rate 10.Proportional mortality rate 11.Case fatality rate 12.Years of potential life lost HEALTH INDICATORS 8
Crude death rate HEALTH INDICATORS 9 π‘›π‘œ. π‘œπ‘“ π‘‘π‘’π‘Žπ‘‘β„Žπ‘  π‘‘π‘’π‘Ÿπ‘–π‘›π‘” π‘‘β„Žπ‘’ π‘¦π‘’π‘Žπ‘Ÿ π‘šπ‘–π‘‘ βˆ’ π‘¦π‘’π‘Žπ‘Ÿ π‘π‘œπ‘π‘’π‘™π‘Žπ‘‘π‘–π‘œπ‘› Γ— 1000 Life expectancy at birth The average number of years that will be lived by those born alive into a population if the current age-specific mortality rates persist Age specific death rate π‘›π‘œ. π‘œπ‘“ π‘‘π‘’π‘Žπ‘‘β„Žπ‘  π‘œπ‘“ π‘π‘’π‘Ÿπ‘ π‘œπ‘›π‘  π‘Žπ‘”π‘’π‘‘ 15 βˆ’ 20 π‘‘π‘’π‘Ÿπ‘–π‘›π‘” π‘Ž π‘π‘Žπ‘™π‘’π‘›π‘‘π‘Žπ‘Ÿ π‘¦π‘’π‘Žπ‘Ÿ π‘šπ‘–π‘‘ βˆ’ π‘¦π‘’π‘Žπ‘Ÿ π‘π‘œπ‘π‘’π‘™π‘Žπ‘‘π‘–π‘œπ‘› Γ— 1000
Infant mortality rate HEALTH INDICATORS 10 π‘›π‘œ. π‘œπ‘“ π‘‘π‘’π‘Žπ‘‘β„Žπ‘  π‘œπ‘“ π‘β„Žπ‘–π‘™π‘‘π‘Ÿπ‘’π‘› 𝑙𝑒𝑠𝑠 π‘‘β„Žπ‘Žπ‘› 1 π‘¦π‘’π‘Žπ‘Ÿ π‘œπ‘“ π‘Žπ‘”π‘’ 𝑖𝑛 π‘Ž π‘¦π‘’π‘Žπ‘Ÿ π‘‘π‘œπ‘‘π‘Žπ‘™ 𝑙𝑖𝑣𝑒 π‘π‘–π‘Ÿπ‘‘β„Žπ‘  𝑖𝑛 π‘‘β„Žπ‘’ π‘ π‘Žπ‘šπ‘’ π‘¦π‘’π‘Žπ‘Ÿ Γ— 1000 Child death rate π‘›π‘œ. π‘œπ‘“ π‘‘π‘’π‘Žπ‘‘β„Žπ‘  π‘œπ‘“ π‘β„Žπ‘–π‘™π‘‘π‘Ÿπ‘’π‘› π‘Žπ‘”π‘’π‘‘ 1 βˆ’ 4 π‘¦π‘’π‘Žπ‘Ÿπ‘  π‘‘π‘’π‘Ÿπ‘–π‘›π‘” π‘Ž π‘¦π‘’π‘Žπ‘Ÿ π‘‘π‘œπ‘‘π‘Žπ‘™ π‘›π‘œ. π‘œπ‘“ π‘β„Žπ‘–π‘™π‘‘π‘Ÿπ‘’π‘› π‘Žπ‘”π‘’π‘‘ 1 βˆ’ 4 π‘¦π‘’π‘Žπ‘Ÿπ‘  π‘Žπ‘‘ π‘‘β„Žπ‘’ π‘šπ‘–π‘‘π‘‘π‘™π‘’ π‘œπ‘“ π‘‘β„Žπ‘’ π‘¦π‘’π‘Žπ‘Ÿ Γ— 1000 Under-5 proportionate mortality rate π‘›π‘œ. π‘œπ‘“ π‘‘π‘’π‘Žπ‘‘β„Žπ‘  π‘œπ‘“ π‘β„Žπ‘–π‘™π‘‘π‘Ÿπ‘’π‘› 𝑙𝑒𝑠𝑠 π‘‘β„Žπ‘Žπ‘› 5 π‘¦π‘’π‘Žπ‘Ÿπ‘  π‘œπ‘“ π‘Žπ‘”π‘’ 𝑖𝑛 π‘Ž 𝑔𝑖𝑣𝑒𝑛 π‘¦π‘’π‘Žπ‘Ÿ π‘›π‘œ. π‘œπ‘“ 𝑙𝑖𝑣𝑒 π‘π‘–π‘Ÿπ‘‘β„Žπ‘  𝑖𝑛 π‘‘β„Žπ‘’ π‘ π‘Žπ‘šπ‘’ π‘¦π‘’π‘Žπ‘Ÿ Γ— 1000
Adult mortality rate HEALTH INDICATORS 11 Probability of dying between the age of 15 and 60 years per 1000 population Disease specific mortality rate π‘›π‘œ. π‘œπ‘“ π‘‘π‘’π‘Žπ‘‘β„Žπ‘  π‘“π‘Ÿπ‘œπ‘š 𝑇𝐡 π‘‘π‘’π‘Ÿπ‘–π‘›π‘” π‘Ž π‘π‘Žπ‘™π‘’π‘›π‘‘π‘Žπ‘Ÿ π‘¦π‘’π‘Žπ‘Ÿ π‘šπ‘–π‘‘ βˆ’ π‘¦π‘’π‘Žπ‘Ÿ π‘π‘œπ‘π‘’π‘™π‘Žπ‘‘π‘–π‘œπ‘› Γ— 1000 Proportional mortality rate π‘›π‘œ. π‘œπ‘“ π‘‘π‘’π‘Žπ‘‘β„Žπ‘  π‘“π‘Ÿπ‘œπ‘š π‘‘β„Žπ‘’ 𝑠𝑝𝑒𝑐𝑖𝑓𝑖𝑐 π‘‘π‘–π‘ π‘’π‘Žπ‘ π‘’ 𝑖𝑛 π‘Ž π‘¦π‘’π‘Žπ‘Ÿ π‘‘π‘œπ‘‘π‘Žπ‘™ π‘‘π‘’π‘Žπ‘‘β„Žπ‘  π‘“π‘Ÿπ‘œπ‘š π‘Žπ‘™π‘™ π‘π‘Žπ‘’π‘ π‘’π‘  𝑖𝑛 π‘‘β„Žπ‘Žπ‘‘ π‘¦π‘’π‘Žπ‘Ÿ Γ— 100
HEALTH INDICATORS 12 Maternal mortality ratio π‘‘π‘œπ‘‘π‘Žπ‘™ π‘›π‘œ. π‘œπ‘“ π‘“π‘’π‘šπ‘Žπ‘™π‘’ π‘‘π‘’π‘Žπ‘‘β„Žπ‘  𝑑𝑒𝑒 π‘‘π‘œ π‘π‘œπ‘šπ‘π‘™π‘–π‘π‘Žπ‘‘π‘–π‘œπ‘›π‘  π‘œπ‘“ π‘π‘Ÿπ‘’π‘”π‘›π‘Žπ‘›π‘π‘¦, π‘β„Žπ‘–π‘™π‘‘π‘π‘–π‘Ÿπ‘‘β„Ž π‘œπ‘Ÿ π‘€π‘–π‘‘β„Žπ‘–π‘› 42 π‘‘π‘Žπ‘¦π‘  π‘œπ‘“ π‘‘π‘’π‘™π‘–π‘£π‘’π‘Ÿπ‘¦ π‘“π‘Ÿπ‘œπ‘š "π‘π‘’π‘’π‘Ÿπ‘π‘’π‘Ÿπ‘Žπ‘™ π‘π‘Žπ‘’π‘ π‘’π‘ " 𝑖𝑛 π‘Žπ‘› π‘Žπ‘Ÿπ‘’π‘Ž π‘‘π‘’π‘Ÿπ‘–π‘›π‘” π‘Ž 𝑔𝑖𝑣𝑒𝑛 π‘¦π‘’π‘Žπ‘Ÿ π‘‘π‘œπ‘‘π‘Žπ‘™ π‘›π‘œ. π‘œπ‘“ 𝑙𝑖𝑣𝑒 π‘π‘–π‘Ÿπ‘‘β„Žπ‘  𝑖𝑛 π‘‘β„Žπ‘’ π‘ π‘Žπ‘šπ‘’ π‘Žπ‘Ÿπ‘’π‘Ž π‘Žπ‘›π‘‘ π‘¦π‘’π‘Žπ‘Ÿ Γ— 100,000 Maternal mortality rate π‘‘π‘œπ‘‘π‘Žπ‘™ π‘›π‘œ. π‘œπ‘“ π‘“π‘’π‘šπ‘Žπ‘™π‘’ π‘‘π‘’π‘Žπ‘‘β„Žπ‘  𝑑𝑒𝑒 π‘‘π‘œ π‘π‘œπ‘šπ‘π‘™π‘–π‘π‘Žπ‘‘π‘–π‘œπ‘›π‘  π‘œπ‘“ π‘π‘Ÿπ‘’π‘”π‘›π‘Žπ‘›π‘π‘¦, π‘β„Žπ‘–π‘™π‘‘π‘π‘–π‘Ÿπ‘‘β„Ž π‘œπ‘Ÿ π‘€π‘–π‘‘β„Žπ‘–π‘› 42 π‘‘π‘Žπ‘¦π‘  π‘œπ‘“ π‘‘π‘’π‘™π‘–π‘£π‘’π‘Ÿπ‘¦ π‘“π‘Ÿπ‘œπ‘š "π‘π‘’π‘’π‘Ÿπ‘π‘’π‘Ÿπ‘Žπ‘™ π‘π‘Žπ‘’π‘ π‘’π‘ " 𝑖𝑛 π‘Žπ‘› π‘Žπ‘Ÿπ‘’π‘Ž π‘‘π‘’π‘Ÿπ‘–π‘›π‘” π‘Ž 𝑔𝑖𝑣𝑒𝑛 π‘¦π‘’π‘Žπ‘Ÿ π‘€π‘œπ‘šπ‘’π‘› π‘œπ‘“ π‘Ÿπ‘’π‘π‘Ÿπ‘œπ‘‘π‘’π‘π‘‘π‘–π‘£π‘’ π‘Žπ‘”π‘’ 𝑖𝑛 π‘‘β„Žπ‘’ π‘ π‘Žπ‘šπ‘’ π‘Žπ‘Ÿπ‘’π‘Ž π‘Žπ‘›π‘‘ π‘¦π‘’π‘Žπ‘Ÿ Γ— 100,000
Case fatality rate HEALTH INDICATORS 13 π‘‘π‘œπ‘‘π‘Žπ‘™ π‘›π‘œ. π‘œπ‘“ π‘‘π‘’π‘Žπ‘‘β„Žπ‘  𝑑𝑒𝑒 π‘‘π‘œ π‘Ž π‘π‘Žπ‘Ÿπ‘‘π‘–π‘π‘’π‘™π‘Žπ‘Ÿ π‘‘π‘–π‘ π‘’π‘Žπ‘ π‘’ π‘‘π‘œπ‘‘π‘Žπ‘™ π‘›π‘œ. π‘œπ‘“ π‘π‘Žπ‘ π‘’π‘  𝑑𝑒𝑒 π‘‘π‘œ π‘‘β„Žπ‘’ π‘ π‘Žπ‘šπ‘’ π‘‘π‘–π‘ π‘’π‘Žπ‘ π‘’ Γ— 100 Years of potential life lost (YPLL) For individual, subtract age at death from average life expectancy For particular cause, subtract the age at death from the standard year, and then sum the individual YPLL across each cause of death
Morbidity indicators Morbidity indicators are used to supplement mortality data to describe the health status of a population HEALTH INDICATORS 14
a) Incidence & Prevalence b) Notification rates c) Attendance rates at OPD etc d) Admission, re-admission, discharge rates e) Duration of stay in hospital f) Spells or sickness or absence from work/school HEALTH INDICATORS 15
Disability rates 1. Event-type indicators 2. Person-type indicators HEALTH INDICATORS 16
Event-type indicators 17 i. Number of days of restricted activity ii. Bed disability days iii. Work-loss days (or school-loss days) within a specified period HEALTH INDICATORS
Person-type indicators 18 i. Limitation of mobility: For example, confined to bed, confined to the house, special aid in getting around either inside or outside the house. ii. Limitation of activity: For example, limitation to perform the basic activities of daily living (ADL)- e.g., eating, washing, dressing, going to toilet, moving about, etc; limitation in major activity, e.g., ability to work at a job, ability to housework, etc HEALTH INDICATORS
HALE (Health Adjusted Life Expectancy) β€’ Based on life expectancy at birth β€’ Includes an adjustment for time spent in poor health β€’ Most easily understood as the equivalent number of years in full health that a newborn can expect to live based on current rates of ill-health and mortality HEALTH INDICATORS 19
QALY (Quality Adjusted Life Years) β€’ Based on the number of years of life that would be added by intervention β€’ Used in assessing the value for money of a medical intervention β€’ Each year in perfect health is assigned a value of 1.0 down to a value of 0.0 for death HEALTH INDICATORS 20
DFLE (Disability-free life expectancy) β€’ Average number of years an individual is expected to live free of disability if current pattern of mortality and disability continue to apply HEALTH INDICATORS 21
DALY (Disability Adjusted Life Years) β€’ DALY = YLL + YLD β€’ years of lost life (YLL) – number of deaths at each age multiplied by the expected remaining years of life β€’ years lost to disability (YLD) – number of incident cases due to injury and illness multiplied by the average duration of the disease and weighting factor HEALTH INDICATORS 22
Nutritional status indicators β€’ Nutritional status is a positive health indicator β€’ Three nutritional status indicators are considered important as indicators of health status HEALTH INDICATORS 23
1. Anthropometric measurements of preschool children, e.g., Weight and height, mid-arm circumference 2. Heights (and sometimes weights) of children at school entry 3. Prevalence of low birth weight (less than 2.5 kg) HEALTH INDICATORS 24
Health care delivery indicators These indicators reflect the equity of distribution of health resources in different parts of the country, and of the provision of health care HEALTH INDICATORS 25
1. Doctor-population ratio 2. Doctor-nurse ratio 3. Population-bed ratio 4. Population per health/sub-centre 5. Population per trained birth attendant HEALTH INDICATORS 26
Utilization rates β€’ Expressed as the proportion of people in need of a service who actually receive it in a given period β€’ Utilization rates give some indication of the care needed by a population β€’ Affected by availability & accessibility of health services, and attitude of individuals HEALTH INDICATORS 27
Examples of utilization rates HEALTH INDICATORS 28 i. Proportion of infants who are β€œfully immunized” ii. Proportion of pregnant women who receive antenatal care, or have their deliveries supervised by SBA iii. Percentage of the population using the various methods of family planning. iv. Bed-occupancy rate v. Average length of stay vi. Bed turnover ratio
Indicators of social and mental health β€’ As valid positive indicators of social and mental health are scarce, it is necessary to use indirect measures β€’ viz., indicators of social and mental pathology HEALTH INDICATORS 29
HEALTH INDICATORS 30 i. Suicide, homicide, other acts of violence and other crime ii. Road traffic accidents, juvenile delinquency iii. Alcohol and drug abuse iv. Suicide, homicide, other acts of violence and other crime v. Road traffic accidents, juvenile delinquency
HEALTH INDICATORS 31 vi. Alcohol and drug abuse vii. Smoking viii. Consumption of tranquillizers ix. Obesity x. Family violence, battered-baby and battered-wife syndromes xi. Neglected and abandoned youth in the neighbourhood
Environmental indicators These reflect the quality of physical and biological environment in which diseases occur and in which people live HEALTH INDICATORS 32
HEALTH INDICATORS 33 They include indicators relating to β€’ Pollution of air and water β€’ Radiation β€’ Solid wastes β€’ Noise β€’ Exposure to toxic substances in food or drink
HEALTH INDICATORS 34 Among these, the most useful indicators are β€’ Percentage of HH with safe water in the home or within 15 minutes' walking distance from a water standpoint or protected well β€’ Adequate sanitary facilities in the home or immediate vicinity
Socio-economic indicators β€’ These indicators do not directly measure health β€’ But important in interpretation of indicators of health care HEALTH INDICATORS 35
HEALTH INDICATORS 36 These include : A. Rate of population increase B. Per capita GNP C. Level of unemployment D. Dependency ratio E. Literacy rates, especially female literacy rates F. Family size G. Housing: the number of persons per room, and H. Per capita β€œcalorie” availability.
Health policy indicators The single most important indicator of political commitment is β€œallocation of adequate resources” HEALTH INDICATORS 37
HEALTH INDICATORS 38 The relevant health policy indicators are: (i) Proportion of GNP spent on health services (ii) Proportion of GNP spent on health-related activities (including water supply and sanitation, housing and nutrition, community development) (iii) Proportion of total health resources devoted to primary health care
Indicators of quality of life β€’ Various attempts have been made to reach one composite index from a number of health indicators β€’ Physical quality of life index is one such index HEALTH INDICATORS 39
HEALTH INDICATORS 40 Physical quality of life index consolidates three indicators 1. Infant mortality 2. Life expectancy at age one 3. Literacy  For each component, performance is scaled 0 to 100, where 0 is β€œworst” and 100 is β€œbest” performance  Composite index is calculated by averaging the 3 indicators  Resulting PQLI thus also is scaled 0 to 100
Social indicators Social indicators have been divided into 12 categories (defined by United Nations Statistical Office) HEALTH INDICATORS 41
HEALTH INDICATORS 42 1. Population 2. Family formation, families and households 3. Learning and educational services 4. Earning activities 5. Distribution of income, consumption, and accumulation 6. Social security and welfare services 7. Health services and nutrition 8. Housing and its environment 9. Public order and safety 10. Time use 11. Leisure and culture 12. Social stratification and mobility
Basic needs indicators These indicators are used by International Labour Organization (ILO) HEALTH INDICATORS 43
HEALTH INDICATORS 44 1. Calorie consumption 2. Access to water 3. Life expectancy 4. Deaths due to disease 5. Illiteracy, doctors and nurses per population 6. Rooms 7. Per person 8. GNP per capita Those mentioned in β€œBasic needs performance” include
SPECIAL INDICATORS SERIES HEALTH INDICATORS 45 1. β€œHealth for All” indicators 2. Millennium Development Goals – Indicators 3. Sustainable Development Goals 4. Global Reference list of Core Health Indicators (2018) 5. Health Index of India (Niti Aayog)
β€œHealth for All” indicators HEALTH INDICATORS 46
HEALTH INDICATORS 47 1. Health policy indicators: β€’ Political commitment to β€œhealth for al!” β€’ Resource allocation β€’ The degree of equity of distribution of health services β€’ Community involvement β€’ Organizational framework and managerial process 2. Social and economic indicators: β€’ Rate of population increase β€’ GNP or GDP β€’ Income distribution β€’ Work conditions β€’ Adult literacy rate β€’ Housing β€’ Food availability
HEALTH INDICATORS 48 3. Indicators for the provision of health care: β€’ Availability β€’ Accessibility β€’ Utilization β€’ Quality of care 4. Health status indicators: β€’ Low birth weight (percentage) β€’ Nutritional status and psychosocial development of children β€’ Infant mortality rate β€’ Child mortality rate β€’ Life expectancy at birth β€’ Maternal mortality rate β€’ Disease specific mortality β€’ Morbidity β€’ Disability prevalence
Millennium Development Goals - Indicators HEALTH INDICATORS 49
HEALTH INDICATORS 50 1. Eradicate extreme poverty and hunger Goal β€’ 4. Prevalence of underweight children under five years of age β€’ 5. Proportion of population below minimum level of dietary energy consumption 4. Reduce child mortality Goal β€’ 13. Under-five mortality rate β€’ 14. Infant mortality rate β€’ 15. Proportion of 1-year-old children immunized against measles 5. Improve maternal health Goal β€’ 16. Maternal mortality ratio β€’ 17. Proportion of births attended by skilled health personnel
HEALTH INDICATORS 51 6. Combat HIV/AIDS, malaria and other diseases Goal β€’ HIV prevalence among young people aged 15 to 24 years β€’ Condom use rate of the contraceptive prevalence rate β€’ Number of children orphaned by HIV AIDS β€’ Prevalence and death rates associated with malaria β€’ Proportion of population in malaria-risk areas using effective malaria prevention and treatment measures β€’ Prevalence and death rates associated with tuberculosis β€’ Proportion of tuberculosis cases detected and cured under Directly Observed Treatment, Short-course (DOTS)
HEALTH INDICATORS 52 7. Ensure environmental sustainability Goal β€’ Proportion of population using solid fuel β€’ Proportion of population with sustainable access to an improved water source, urban and rural β€’ Proportion of urban population with access to improved sanitation 8. Develop a global partnership for development Goal β€’ Proportion of population with access to affordable essential drugs on a sustainable basis
Sustainable Development Goals HEALTH INDICATORS 53
HEALTH INDICATORS 54 β€’ On 25th September 2015, the United Nations General Assembly adopted the new development agenda β€œTransforming our world : the 2030 agenda for sustainable development”. β€’ The post-2015 framework goes beyond the MDGs β€’ It has 17 goals and 169 targets, including one specific (3rd goal) for health with 13 targets
Global Reference list of Core Health Indicators (2018) HEALTH INDICATORS 55
HEALTH INDICATORS 56 β€’ The Global Reference List is a standard set of 100 core indicators β€’ Overall aim is to serve as a normative guidance for the selection of standard indicators and monitoring β€’ It reflects indicators across the full spectrum of global health priorities β€’ The list includes a selection of priority indicators relating to 4 domains that includes health status, risk factors, service coverage and health systems
HEALTH INDICATORS 57 Health status indicators β€’ include core indicators including mortality by age, sex and cause Risk factors indicators β€’ include those relating to nutrition, environmental, behavioural, injuries and violence
HEALTH INDICATORS 58 Service coverage indicators β€’ reflect priorities across the spectrum of health services including reproductive, maternal, newborn, child and adolescent, immunization, HIV, TB, malaria, neglected tropical diseases, noncommunicable diseases, mental health and substance abuse Health systems indicators β€’ include indicators of health system inputs and outputs such as health facility density and distribution, health workforce, health information and quality and safety of care, health security capacity
Health Index of India (Niti Aayog) HEALTH INDICATORS 59
HEALTH INDICATORS 60 β€’ Niti Aayog of India recently ranked all states and UTs in an attempt to measure the nations health performance β€’ The states and UTs are grouped in three categories to ensure comparisons among similar entities namely  21 larger states  8 smaller states  7 Union Territories
HEALTH INDICATORS 61 β€’ The health index is a weighted composite index, which is based on indicators in three domains: a) Health outcomes (70 per cent) b) Governance and information (12 percent) c) Key inputs and processes (18 per cent) β€’ Each domain is assigned a weight based on its importance β€’ Within a domain or sub-domain, the weight has been equally distributed among the indicators
Summary β€’ Health is multidimensional β€’ The subject of health measurement is a complicated one β€’ Our understanding of health cannot be in terms of a single indicator β€’ It must be conceived in terms of a profile, employing many indicators HEALTH INDICATORS 62 62
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Measure Community Health Status

  • 2. How healthy is a given community?
  • 4. Introduction Indicators are defined as variables which help to measure changes HEALTH INDICATORS 4 Measure health status Compare health status Assess health care needs Allocation of scarce resources Monitoring & evaluation Health indicators are required to: Indicators help to measure the extent to which the objectives and targets of a programme are being attained
  • 5. Characteristics of indicators β€’ Valid β€’ Reliable β€’ Sensitive β€’ Specific β€’ Feasible β€’ Relevant HEALTH INDICATORS 5
  • 6. Classification of indicators HEALTH INDICATORS 6 1. Mortality indicators 2. Morbidity indicators 3. Disability rates 4. Nutritional status indicators 5. Health care delivery indicators 6. Utilization rates 7. Indicators of social and mental health 8. Environmental indicators 9. Socio-economic indicators 10.Health policy indicators 11.Indicators of quality of life 12.Other indicators
  • 7. Mortality indicators 1. Crude death rate 2. Expectation of life 3. Age-specific death rates 4. Infant mortality rate 5. Child death rate HEALTH INDICATORS 7
  • 8. 6. Under-5 proportionate mortality rate 7. Adult mortality rate 8. Maternal mortality rate 9. Disease-specific mortality rate 10.Proportional mortality rate 11.Case fatality rate 12.Years of potential life lost HEALTH INDICATORS 8
  • 9. Crude death rate HEALTH INDICATORS 9 π‘›π‘œ. π‘œπ‘“ π‘‘π‘’π‘Žπ‘‘β„Žπ‘  π‘‘π‘’π‘Ÿπ‘–π‘›π‘” π‘‘β„Žπ‘’ π‘¦π‘’π‘Žπ‘Ÿ π‘šπ‘–π‘‘ βˆ’ π‘¦π‘’π‘Žπ‘Ÿ π‘π‘œπ‘π‘’π‘™π‘Žπ‘‘π‘–π‘œπ‘› Γ— 1000 Life expectancy at birth The average number of years that will be lived by those born alive into a population if the current age-specific mortality rates persist Age specific death rate π‘›π‘œ. π‘œπ‘“ π‘‘π‘’π‘Žπ‘‘β„Žπ‘  π‘œπ‘“ π‘π‘’π‘Ÿπ‘ π‘œπ‘›π‘  π‘Žπ‘”π‘’π‘‘ 15 βˆ’ 20 π‘‘π‘’π‘Ÿπ‘–π‘›π‘” π‘Ž π‘π‘Žπ‘™π‘’π‘›π‘‘π‘Žπ‘Ÿ π‘¦π‘’π‘Žπ‘Ÿ π‘šπ‘–π‘‘ βˆ’ π‘¦π‘’π‘Žπ‘Ÿ π‘π‘œπ‘π‘’π‘™π‘Žπ‘‘π‘–π‘œπ‘› Γ— 1000
  • 10. Infant mortality rate HEALTH INDICATORS 10 π‘›π‘œ. π‘œπ‘“ π‘‘π‘’π‘Žπ‘‘β„Žπ‘  π‘œπ‘“ π‘β„Žπ‘–π‘™π‘‘π‘Ÿπ‘’π‘› 𝑙𝑒𝑠𝑠 π‘‘β„Žπ‘Žπ‘› 1 π‘¦π‘’π‘Žπ‘Ÿ π‘œπ‘“ π‘Žπ‘”π‘’ 𝑖𝑛 π‘Ž π‘¦π‘’π‘Žπ‘Ÿ π‘‘π‘œπ‘‘π‘Žπ‘™ 𝑙𝑖𝑣𝑒 π‘π‘–π‘Ÿπ‘‘β„Žπ‘  𝑖𝑛 π‘‘β„Žπ‘’ π‘ π‘Žπ‘šπ‘’ π‘¦π‘’π‘Žπ‘Ÿ Γ— 1000 Child death rate π‘›π‘œ. π‘œπ‘“ π‘‘π‘’π‘Žπ‘‘β„Žπ‘  π‘œπ‘“ π‘β„Žπ‘–π‘™π‘‘π‘Ÿπ‘’π‘› π‘Žπ‘”π‘’π‘‘ 1 βˆ’ 4 π‘¦π‘’π‘Žπ‘Ÿπ‘  π‘‘π‘’π‘Ÿπ‘–π‘›π‘” π‘Ž π‘¦π‘’π‘Žπ‘Ÿ π‘‘π‘œπ‘‘π‘Žπ‘™ π‘›π‘œ. π‘œπ‘“ π‘β„Žπ‘–π‘™π‘‘π‘Ÿπ‘’π‘› π‘Žπ‘”π‘’π‘‘ 1 βˆ’ 4 π‘¦π‘’π‘Žπ‘Ÿπ‘  π‘Žπ‘‘ π‘‘β„Žπ‘’ π‘šπ‘–π‘‘π‘‘π‘™π‘’ π‘œπ‘“ π‘‘β„Žπ‘’ π‘¦π‘’π‘Žπ‘Ÿ Γ— 1000 Under-5 proportionate mortality rate π‘›π‘œ. π‘œπ‘“ π‘‘π‘’π‘Žπ‘‘β„Žπ‘  π‘œπ‘“ π‘β„Žπ‘–π‘™π‘‘π‘Ÿπ‘’π‘› 𝑙𝑒𝑠𝑠 π‘‘β„Žπ‘Žπ‘› 5 π‘¦π‘’π‘Žπ‘Ÿπ‘  π‘œπ‘“ π‘Žπ‘”π‘’ 𝑖𝑛 π‘Ž 𝑔𝑖𝑣𝑒𝑛 π‘¦π‘’π‘Žπ‘Ÿ π‘›π‘œ. π‘œπ‘“ 𝑙𝑖𝑣𝑒 π‘π‘–π‘Ÿπ‘‘β„Žπ‘  𝑖𝑛 π‘‘β„Žπ‘’ π‘ π‘Žπ‘šπ‘’ π‘¦π‘’π‘Žπ‘Ÿ Γ— 1000
  • 11. Adult mortality rate HEALTH INDICATORS 11 Probability of dying between the age of 15 and 60 years per 1000 population Disease specific mortality rate π‘›π‘œ. π‘œπ‘“ π‘‘π‘’π‘Žπ‘‘β„Žπ‘  π‘“π‘Ÿπ‘œπ‘š 𝑇𝐡 π‘‘π‘’π‘Ÿπ‘–π‘›π‘” π‘Ž π‘π‘Žπ‘™π‘’π‘›π‘‘π‘Žπ‘Ÿ π‘¦π‘’π‘Žπ‘Ÿ π‘šπ‘–π‘‘ βˆ’ π‘¦π‘’π‘Žπ‘Ÿ π‘π‘œπ‘π‘’π‘™π‘Žπ‘‘π‘–π‘œπ‘› Γ— 1000 Proportional mortality rate π‘›π‘œ. π‘œπ‘“ π‘‘π‘’π‘Žπ‘‘β„Žπ‘  π‘“π‘Ÿπ‘œπ‘š π‘‘β„Žπ‘’ 𝑠𝑝𝑒𝑐𝑖𝑓𝑖𝑐 π‘‘π‘–π‘ π‘’π‘Žπ‘ π‘’ 𝑖𝑛 π‘Ž π‘¦π‘’π‘Žπ‘Ÿ π‘‘π‘œπ‘‘π‘Žπ‘™ π‘‘π‘’π‘Žπ‘‘β„Žπ‘  π‘“π‘Ÿπ‘œπ‘š π‘Žπ‘™π‘™ π‘π‘Žπ‘’π‘ π‘’π‘  𝑖𝑛 π‘‘β„Žπ‘Žπ‘‘ π‘¦π‘’π‘Žπ‘Ÿ Γ— 100
  • 12. HEALTH INDICATORS 12 Maternal mortality ratio π‘‘π‘œπ‘‘π‘Žπ‘™ π‘›π‘œ. π‘œπ‘“ π‘“π‘’π‘šπ‘Žπ‘™π‘’ π‘‘π‘’π‘Žπ‘‘β„Žπ‘  𝑑𝑒𝑒 π‘‘π‘œ π‘π‘œπ‘šπ‘π‘™π‘–π‘π‘Žπ‘‘π‘–π‘œπ‘›π‘  π‘œπ‘“ π‘π‘Ÿπ‘’π‘”π‘›π‘Žπ‘›π‘π‘¦, π‘β„Žπ‘–π‘™π‘‘π‘π‘–π‘Ÿπ‘‘β„Ž π‘œπ‘Ÿ π‘€π‘–π‘‘β„Žπ‘–π‘› 42 π‘‘π‘Žπ‘¦π‘  π‘œπ‘“ π‘‘π‘’π‘™π‘–π‘£π‘’π‘Ÿπ‘¦ π‘“π‘Ÿπ‘œπ‘š "π‘π‘’π‘’π‘Ÿπ‘π‘’π‘Ÿπ‘Žπ‘™ π‘π‘Žπ‘’π‘ π‘’π‘ " 𝑖𝑛 π‘Žπ‘› π‘Žπ‘Ÿπ‘’π‘Ž π‘‘π‘’π‘Ÿπ‘–π‘›π‘” π‘Ž 𝑔𝑖𝑣𝑒𝑛 π‘¦π‘’π‘Žπ‘Ÿ π‘‘π‘œπ‘‘π‘Žπ‘™ π‘›π‘œ. π‘œπ‘“ 𝑙𝑖𝑣𝑒 π‘π‘–π‘Ÿπ‘‘β„Žπ‘  𝑖𝑛 π‘‘β„Žπ‘’ π‘ π‘Žπ‘šπ‘’ π‘Žπ‘Ÿπ‘’π‘Ž π‘Žπ‘›π‘‘ π‘¦π‘’π‘Žπ‘Ÿ Γ— 100,000 Maternal mortality rate π‘‘π‘œπ‘‘π‘Žπ‘™ π‘›π‘œ. π‘œπ‘“ π‘“π‘’π‘šπ‘Žπ‘™π‘’ π‘‘π‘’π‘Žπ‘‘β„Žπ‘  𝑑𝑒𝑒 π‘‘π‘œ π‘π‘œπ‘šπ‘π‘™π‘–π‘π‘Žπ‘‘π‘–π‘œπ‘›π‘  π‘œπ‘“ π‘π‘Ÿπ‘’π‘”π‘›π‘Žπ‘›π‘π‘¦, π‘β„Žπ‘–π‘™π‘‘π‘π‘–π‘Ÿπ‘‘β„Ž π‘œπ‘Ÿ π‘€π‘–π‘‘β„Žπ‘–π‘› 42 π‘‘π‘Žπ‘¦π‘  π‘œπ‘“ π‘‘π‘’π‘™π‘–π‘£π‘’π‘Ÿπ‘¦ π‘“π‘Ÿπ‘œπ‘š "π‘π‘’π‘’π‘Ÿπ‘π‘’π‘Ÿπ‘Žπ‘™ π‘π‘Žπ‘’π‘ π‘’π‘ " 𝑖𝑛 π‘Žπ‘› π‘Žπ‘Ÿπ‘’π‘Ž π‘‘π‘’π‘Ÿπ‘–π‘›π‘” π‘Ž 𝑔𝑖𝑣𝑒𝑛 π‘¦π‘’π‘Žπ‘Ÿ π‘€π‘œπ‘šπ‘’π‘› π‘œπ‘“ π‘Ÿπ‘’π‘π‘Ÿπ‘œπ‘‘π‘’π‘π‘‘π‘–π‘£π‘’ π‘Žπ‘”π‘’ 𝑖𝑛 π‘‘β„Žπ‘’ π‘ π‘Žπ‘šπ‘’ π‘Žπ‘Ÿπ‘’π‘Ž π‘Žπ‘›π‘‘ π‘¦π‘’π‘Žπ‘Ÿ Γ— 100,000
  • 13. Case fatality rate HEALTH INDICATORS 13 π‘‘π‘œπ‘‘π‘Žπ‘™ π‘›π‘œ. π‘œπ‘“ π‘‘π‘’π‘Žπ‘‘β„Žπ‘  𝑑𝑒𝑒 π‘‘π‘œ π‘Ž π‘π‘Žπ‘Ÿπ‘‘π‘–π‘π‘’π‘™π‘Žπ‘Ÿ π‘‘π‘–π‘ π‘’π‘Žπ‘ π‘’ π‘‘π‘œπ‘‘π‘Žπ‘™ π‘›π‘œ. π‘œπ‘“ π‘π‘Žπ‘ π‘’π‘  𝑑𝑒𝑒 π‘‘π‘œ π‘‘β„Žπ‘’ π‘ π‘Žπ‘šπ‘’ π‘‘π‘–π‘ π‘’π‘Žπ‘ π‘’ Γ— 100 Years of potential life lost (YPLL) For individual, subtract age at death from average life expectancy For particular cause, subtract the age at death from the standard year, and then sum the individual YPLL across each cause of death
  • 14. Morbidity indicators Morbidity indicators are used to supplement mortality data to describe the health status of a population HEALTH INDICATORS 14
  • 15. a) Incidence & Prevalence b) Notification rates c) Attendance rates at OPD etc d) Admission, re-admission, discharge rates e) Duration of stay in hospital f) Spells or sickness or absence from work/school HEALTH INDICATORS 15
  • 16. Disability rates 1. Event-type indicators 2. Person-type indicators HEALTH INDICATORS 16
  • 17. Event-type indicators 17 i. Number of days of restricted activity ii. Bed disability days iii. Work-loss days (or school-loss days) within a specified period HEALTH INDICATORS
  • 18. Person-type indicators 18 i. Limitation of mobility: For example, confined to bed, confined to the house, special aid in getting around either inside or outside the house. ii. Limitation of activity: For example, limitation to perform the basic activities of daily living (ADL)- e.g., eating, washing, dressing, going to toilet, moving about, etc; limitation in major activity, e.g., ability to work at a job, ability to housework, etc HEALTH INDICATORS
  • 19. HALE (Health Adjusted Life Expectancy) β€’ Based on life expectancy at birth β€’ Includes an adjustment for time spent in poor health β€’ Most easily understood as the equivalent number of years in full health that a newborn can expect to live based on current rates of ill-health and mortality HEALTH INDICATORS 19
  • 20. QALY (Quality Adjusted Life Years) β€’ Based on the number of years of life that would be added by intervention β€’ Used in assessing the value for money of a medical intervention β€’ Each year in perfect health is assigned a value of 1.0 down to a value of 0.0 for death HEALTH INDICATORS 20
  • 21. DFLE (Disability-free life expectancy) β€’ Average number of years an individual is expected to live free of disability if current pattern of mortality and disability continue to apply HEALTH INDICATORS 21
  • 22. DALY (Disability Adjusted Life Years) β€’ DALY = YLL + YLD β€’ years of lost life (YLL) – number of deaths at each age multiplied by the expected remaining years of life β€’ years lost to disability (YLD) – number of incident cases due to injury and illness multiplied by the average duration of the disease and weighting factor HEALTH INDICATORS 22
  • 23. Nutritional status indicators β€’ Nutritional status is a positive health indicator β€’ Three nutritional status indicators are considered important as indicators of health status HEALTH INDICATORS 23
  • 24. 1. Anthropometric measurements of preschool children, e.g., Weight and height, mid-arm circumference 2. Heights (and sometimes weights) of children at school entry 3. Prevalence of low birth weight (less than 2.5 kg) HEALTH INDICATORS 24
  • 25. Health care delivery indicators These indicators reflect the equity of distribution of health resources in different parts of the country, and of the provision of health care HEALTH INDICATORS 25
  • 26. 1. Doctor-population ratio 2. Doctor-nurse ratio 3. Population-bed ratio 4. Population per health/sub-centre 5. Population per trained birth attendant HEALTH INDICATORS 26
  • 27. Utilization rates β€’ Expressed as the proportion of people in need of a service who actually receive it in a given period β€’ Utilization rates give some indication of the care needed by a population β€’ Affected by availability & accessibility of health services, and attitude of individuals HEALTH INDICATORS 27
  • 28. Examples of utilization rates HEALTH INDICATORS 28 i. Proportion of infants who are β€œfully immunized” ii. Proportion of pregnant women who receive antenatal care, or have their deliveries supervised by SBA iii. Percentage of the population using the various methods of family planning. iv. Bed-occupancy rate v. Average length of stay vi. Bed turnover ratio
  • 29. Indicators of social and mental health β€’ As valid positive indicators of social and mental health are scarce, it is necessary to use indirect measures β€’ viz., indicators of social and mental pathology HEALTH INDICATORS 29
  • 30. HEALTH INDICATORS 30 i. Suicide, homicide, other acts of violence and other crime ii. Road traffic accidents, juvenile delinquency iii. Alcohol and drug abuse iv. Suicide, homicide, other acts of violence and other crime v. Road traffic accidents, juvenile delinquency
  • 31. HEALTH INDICATORS 31 vi. Alcohol and drug abuse vii. Smoking viii. Consumption of tranquillizers ix. Obesity x. Family violence, battered-baby and battered-wife syndromes xi. Neglected and abandoned youth in the neighbourhood
  • 32. Environmental indicators These reflect the quality of physical and biological environment in which diseases occur and in which people live HEALTH INDICATORS 32
  • 33. HEALTH INDICATORS 33 They include indicators relating to β€’ Pollution of air and water β€’ Radiation β€’ Solid wastes β€’ Noise β€’ Exposure to toxic substances in food or drink
  • 34. HEALTH INDICATORS 34 Among these, the most useful indicators are β€’ Percentage of HH with safe water in the home or within 15 minutes' walking distance from a water standpoint or protected well β€’ Adequate sanitary facilities in the home or immediate vicinity
  • 35. Socio-economic indicators β€’ These indicators do not directly measure health β€’ But important in interpretation of indicators of health care HEALTH INDICATORS 35
  • 36. HEALTH INDICATORS 36 These include : A. Rate of population increase B. Per capita GNP C. Level of unemployment D. Dependency ratio E. Literacy rates, especially female literacy rates F. Family size G. Housing: the number of persons per room, and H. Per capita β€œcalorie” availability.
  • 37. Health policy indicators The single most important indicator of political commitment is β€œallocation of adequate resources” HEALTH INDICATORS 37
  • 38. HEALTH INDICATORS 38 The relevant health policy indicators are: (i) Proportion of GNP spent on health services (ii) Proportion of GNP spent on health-related activities (including water supply and sanitation, housing and nutrition, community development) (iii) Proportion of total health resources devoted to primary health care
  • 39. Indicators of quality of life β€’ Various attempts have been made to reach one composite index from a number of health indicators β€’ Physical quality of life index is one such index HEALTH INDICATORS 39
  • 40. HEALTH INDICATORS 40 Physical quality of life index consolidates three indicators 1. Infant mortality 2. Life expectancy at age one 3. Literacy  For each component, performance is scaled 0 to 100, where 0 is β€œworst” and 100 is β€œbest” performance  Composite index is calculated by averaging the 3 indicators  Resulting PQLI thus also is scaled 0 to 100
  • 41. Social indicators Social indicators have been divided into 12 categories (defined by United Nations Statistical Office) HEALTH INDICATORS 41
  • 42. HEALTH INDICATORS 42 1. Population 2. Family formation, families and households 3. Learning and educational services 4. Earning activities 5. Distribution of income, consumption, and accumulation 6. Social security and welfare services 7. Health services and nutrition 8. Housing and its environment 9. Public order and safety 10. Time use 11. Leisure and culture 12. Social stratification and mobility
  • 43. Basic needs indicators These indicators are used by International Labour Organization (ILO) HEALTH INDICATORS 43
  • 44. HEALTH INDICATORS 44 1. Calorie consumption 2. Access to water 3. Life expectancy 4. Deaths due to disease 5. Illiteracy, doctors and nurses per population 6. Rooms 7. Per person 8. GNP per capita Those mentioned in β€œBasic needs performance” include
  • 45. SPECIAL INDICATORS SERIES HEALTH INDICATORS 45 1. β€œHealth for All” indicators 2. Millennium Development Goals – Indicators 3. Sustainable Development Goals 4. Global Reference list of Core Health Indicators (2018) 5. Health Index of India (Niti Aayog)
  • 47. HEALTH INDICATORS 47 1. Health policy indicators: β€’ Political commitment to β€œhealth for al!” β€’ Resource allocation β€’ The degree of equity of distribution of health services β€’ Community involvement β€’ Organizational framework and managerial process 2. Social and economic indicators: β€’ Rate of population increase β€’ GNP or GDP β€’ Income distribution β€’ Work conditions β€’ Adult literacy rate β€’ Housing β€’ Food availability
  • 48. HEALTH INDICATORS 48 3. Indicators for the provision of health care: β€’ Availability β€’ Accessibility β€’ Utilization β€’ Quality of care 4. Health status indicators: β€’ Low birth weight (percentage) β€’ Nutritional status and psychosocial development of children β€’ Infant mortality rate β€’ Child mortality rate β€’ Life expectancy at birth β€’ Maternal mortality rate β€’ Disease specific mortality β€’ Morbidity β€’ Disability prevalence
  • 50. HEALTH INDICATORS 50 1. Eradicate extreme poverty and hunger Goal β€’ 4. Prevalence of underweight children under five years of age β€’ 5. Proportion of population below minimum level of dietary energy consumption 4. Reduce child mortality Goal β€’ 13. Under-five mortality rate β€’ 14. Infant mortality rate β€’ 15. Proportion of 1-year-old children immunized against measles 5. Improve maternal health Goal β€’ 16. Maternal mortality ratio β€’ 17. Proportion of births attended by skilled health personnel
  • 51. HEALTH INDICATORS 51 6. Combat HIV/AIDS, malaria and other diseases Goal β€’ HIV prevalence among young people aged 15 to 24 years β€’ Condom use rate of the contraceptive prevalence rate β€’ Number of children orphaned by HIV AIDS β€’ Prevalence and death rates associated with malaria β€’ Proportion of population in malaria-risk areas using effective malaria prevention and treatment measures β€’ Prevalence and death rates associated with tuberculosis β€’ Proportion of tuberculosis cases detected and cured under Directly Observed Treatment, Short-course (DOTS)
  • 52. HEALTH INDICATORS 52 7. Ensure environmental sustainability Goal β€’ Proportion of population using solid fuel β€’ Proportion of population with sustainable access to an improved water source, urban and rural β€’ Proportion of urban population with access to improved sanitation 8. Develop a global partnership for development Goal β€’ Proportion of population with access to affordable essential drugs on a sustainable basis
  • 54. HEALTH INDICATORS 54 β€’ On 25th September 2015, the United Nations General Assembly adopted the new development agenda β€œTransforming our world : the 2030 agenda for sustainable development”. β€’ The post-2015 framework goes beyond the MDGs β€’ It has 17 goals and 169 targets, including one specific (3rd goal) for health with 13 targets
  • 55. Global Reference list of Core Health Indicators (2018) HEALTH INDICATORS 55
  • 56. HEALTH INDICATORS 56 β€’ The Global Reference List is a standard set of 100 core indicators β€’ Overall aim is to serve as a normative guidance for the selection of standard indicators and monitoring β€’ It reflects indicators across the full spectrum of global health priorities β€’ The list includes a selection of priority indicators relating to 4 domains that includes health status, risk factors, service coverage and health systems
  • 57. HEALTH INDICATORS 57 Health status indicators β€’ include core indicators including mortality by age, sex and cause Risk factors indicators β€’ include those relating to nutrition, environmental, behavioural, injuries and violence
  • 58. HEALTH INDICATORS 58 Service coverage indicators β€’ reflect priorities across the spectrum of health services including reproductive, maternal, newborn, child and adolescent, immunization, HIV, TB, malaria, neglected tropical diseases, noncommunicable diseases, mental health and substance abuse Health systems indicators β€’ include indicators of health system inputs and outputs such as health facility density and distribution, health workforce, health information and quality and safety of care, health security capacity
  • 59. Health Index of India (Niti Aayog) HEALTH INDICATORS 59
  • 60. HEALTH INDICATORS 60 β€’ Niti Aayog of India recently ranked all states and UTs in an attempt to measure the nations health performance β€’ The states and UTs are grouped in three categories to ensure comparisons among similar entities namely  21 larger states  8 smaller states  7 Union Territories
  • 61. HEALTH INDICATORS 61 β€’ The health index is a weighted composite index, which is based on indicators in three domains: a) Health outcomes (70 per cent) b) Governance and information (12 percent) c) Key inputs and processes (18 per cent) β€’ Each domain is assigned a weight based on its importance β€’ Within a domain or sub-domain, the weight has been equally distributed among the indicators
  • 62. Summary β€’ Health is multidimensional β€’ The subject of health measurement is a complicated one β€’ Our understanding of health cannot be in terms of a single indicator β€’ It must be conceived in terms of a profile, employing many indicators HEALTH INDICATORS 62 62