Describes much about health status and indicators of health

1. HEALTH STATUS OF
THE COMMUNITY
Mrs.Madhurima.D
Community Health Nursing Department
Hindu Mission College of Nursing

2. INTRODUCTION
According to the National Health Report 2015
• Around 55 percent of Indian women aged between 15 and 49
have anaemia or low blood cell count.
• Over 38 percent of children in India have stunted growth
• 18.6 percent children under three years have low birth weight
(under 2.5 kilograms)

4. What all these data shows?

5. Definitions
HEALTH
Health is a state of physical, mental, social and spiritual wellbeing
not merely an absence of disease.
……WHO
ILLNESS
Illness is defined as a sickness or disease, or to a period of
sickness and disease.
Segen's Medical Dictionary.

6. Definitions
• DISEASE
A disorder of structure or function in a human, animal, or plant,
especially one that produces specific symptoms or that affects a
specific location and is not simply a direct result of physical injury.
Segen's Medical Dictionary.

7. Definitions
WELLNESS
"A conscious, self-directed and evolving process of achieving full
potential."
- The National Wellness Institute

8. Illness wellness continuum

9. Definition of a “Community”
• A social group of any size whose members reside in a specific
locality, share government, and often have a common cultural
and historical heritage.
• A group of people with a common characteristic or interest
living together within a larger society

10. Health status of the community
• A generic term referring to the health (good or poor) of a
person, group or population in a particular area, especially
when compared to other areas or with national data.
• Segen's Medical Dictionary.

11. Indicator
• “A parameter, or a value derived from parameters, which
points to/provides information about/describes the state of a
phenomenon/ environment/area with a significance extending
beyond that directly associated with a parameter value”
• The Organisation for Economic Co-operation and
Development (OECD)

12. INDICATORS IN SIMPLE TO
UNDERSTAND
Indicators of healthare variables used for the
assessment of community health.

13. Characteristics of Indicators:
• a. should be valid, i.e., they should actually measure what they are
supposed to measure;
• b. should be reliable and objective, i.e., the answers should be the same if
measured by different people in similar circumstances;
• c. should be sensitive, i.e., they should be sensitive to changes in the
situation concerned,
• d. should be specific, i.e., they should reflect changes only in the situation
concerned,
• e. should be feasible, i.e., they should have the ability to obtain data
needed, and;
• f. should be relevant, i.e., they should contribute to the understanding
of the phenomenon of interest.

14. Classification of Indicators
• QUANTITATIVE INDICATORS
• QUALITATIVE INDICATORS

15. QUANTITATIVE INDICATORS
• Quantitative indicators are those that measure quantity,
usually as rate or ratio. For example:
Infant Mortality rate
Birth rate is a quantitative indicator,

16. QUALITATIVE INDICATORS
• Qualitative indicators can be defined as people’s judgment or
perception about a subject.
• For example “perception towards “HIV/AIDS” affected
person”, or “Quality of life” of elderly in a community.

17. HIERARCHY OF INDICATORS
FOR A HEALTH:
• INPUT INDICATOR
• PROCESS INDICATOR
• OUTPUT INDICATOR
• OUTCOME INDICATORS
• IMPACT INDICATORS

18. INDICATORS OF HEALTH STATUS
• Mortality indicators
• Morbidity indicators
• Disability rates
• Nutritional status
indicators
• Health care delivery
indicators
• Utilization rates
• Indicators of social and
mental health
• Environmental indicators
• Socio-economic indicators
• Health policy indicators
• Indicators of quality of life

19. Mortality Indicators
 Mortality Rates
- The traditional measures of health status.
- Widely used because of their ready availability.( death certificate is a legal
requirement in many countries)
 Crude death rates
 Specific death rates: age/disease
 Expectation of life
 Infant mortality rate
 Maternal mortality rate
 Proportionate mortality ratio
 Case Fatality rate

20. MORTALITY INDICATORS
• CRUDE DEATH RATE
• The ratio of total deaths to total population in a specified
community or area over a specified period of time. The death
rate is often expressed as the number of deaths per 1,000 of
the population per year. Also called fatality rate

21. MORTALITY INDICATORS
• EXPECTATION OF LIFE
• The amount of years left in the life of the average person of a
certain age, as determined by a mortality table

22. MORTALITY INDICATORS
• MATERNAL MORTALITY RATE
• "The death of a woman while pregnant or within 42 days of
termination of pregnancy, irrespective of the duration and the site
of the pregnancy, from any cause related to or aggravated by the
pregnancy or its management, but not from accidental or incidental
causes."

23. MORTALITY INDICATORS
• INFANT MORTALITY RATE
• Infant mortality rate (IMR) is the number of deaths of children
less than one year of age per 1000 live births. The rate for a
given region is the number of children dying under one year of
age, divided by the number of live births during the year,
multiplied by 1,000.
•

24. MORTALITY INDICATORS
CHILD MORTALITY RATE
• Child mortality, also known as under-5 mortality or child
death, refers to the death of infants and children under the
age of five or between the age of one month to four years
depending on the definition.

25. MORTALITY INDICATORS
• DISEASE SPECIFIC MORTALITY
• A total or crude mortality rate utilizes deaths from all causes,
usually expressed as deaths per 1,000. A disease-specific
mortality rate covers deaths due to only one disease and is
often reported on the basis of 100,000 persons. The
population base may be defined by gender, age or other
characteristics.

26. Morbidity Indicators
 Morbidity rates
- Data on morbidity are preferable,
although often difficult to obtain.
 Incidence and prevalence
 Notification rates
 Attendance rates: out-patient
clinics or health centers.
 Admission and discharge rates
 Hospital stay duration rates

27. MORBIDITY INDICATORS
• INCIDENCE
Incidence in epidemiology is a measure of the probability of
occurrence of a given medical condition in a population within a
specified period of time.

28. MORBIDITY INDICATORS
PREVALENCE
It is arrived at by comparing the number of people found to have
the condition with the total number of people studied, and is
usually expressed as a fraction, as a percentage, or as the number
of cases per 10,000 or 100,000 people

29. • Event type indicators:
• – Number of days of restricted activity
• – Bed disability days
• – Work‐loss days within a specified period
• Person‐type indicators:
• – Limitation of mobility
• – Limitation of activity (ADL)
• – Expectation of life free of disability
Disability Indicators

30. HALE Healthy life expectancy
HALE is defined as Average number of years that a person can
expect to live in “full health”, by taking into account years lived in
less than full health due to disease and/or injury.

31. DALY: The Disability
Adjusted Life Year
Number of years lost due to ill‐health, disability or ill‐ health.

32. QALY: Quality Adjusted Life
Year
• QALY measures years of survival weighted for the quality of
life, which people may be expected to have in the context of
different states of illness.
• Number of years of life that would be added by a medical
intervention.

33. YLL :Years of life lost
(percentage of total)
YLL are calculated from the number of deaths multiplied by a
standard life expectancy at the age at which death occurs.

34. Nutritional Indicators
 Nutritional Status
Indicators
- It is an indicator of positive health
 Anthropometrics measurements
 Height of children at school entry
 Prevalence of low birth weight
 Clinical surveys: Anaemia,
Hypothyroidism, Nightblindness

35. Health Care Delivery Indicators
 Health Care Delivery
Indicators
- Reflect the Equity / Provision of
health care
 Doctor / Population ratio
 Doctor / Nurse ratio
 Population / Bed ratio
 Population / per health center

36. Utilization Indicators
 Health care utilization
Rates
- Extent of use of health services
- Proportion of people in need of service
who actually receive it in a given
period
 Proportion of infants who are
fully immunized in the 1st year
of life.
i.e..immunization coverage.
 Proportion of pregnant women
who receive ANC.
 Hospital-Beds occupancy rate.
 Hospital-Beds turn-over ratio

37. Social/Mental Health Indicators
 Indicators of Social and
Mental Health
- Valid positive indicators does not often
exist
- Indirect measures are commonly used
 Suicide & Homicide rates
 Road traffic accidents
 Alcohol and drug
abuse.

38. Environmental Indicators
 Environmental health
Indicators
- Reflect the quality of environment
 Measures of Pollution
 The proportion of people
having access to safe water
and sanitation facilities
 Vectors density

39. Socio-economic Indicators
 Socio-economic
Indicators
- Is not a direct measure of health
status.
- For interpretation of health care
indicators.
 Rate of population increase
 Per capita GNP
 Level of unemployment
 Literacy rates - females
 Family size
 Housing condition e.g. No. of
persons per room

40. Health Policy Indicators
 Health Policy Indicators
- Allocation of adequate resources.
 Proportion of GNP spent on
health services.
 Proportion of GNP spent on
health related activities.
 Proportion of total health
resources devoted to primary
health care

41. Other Indicators
 Other health
indicators
 Indicators of quality of life.
 Basic needs indicators.
 Health for all indicators.

42. Definition of Community Diagnosis
• Community diagnosis generally refers to the identification and
quantification of health problems in a community as a whole
in terms of mortality and morbidity rates and ratios, and
identification of their correlates for the purpose of defining
those at risk or those in need of health care.

43. Definition by WHO
“a quantitative and qualitative description of the health of
citizens and the factors which influence their health. It identifies
problems, proposes areas for improvement and stimulates
action”.

44. Goal
• The mission of community diagnosis is to:
• Analyze the health status of the community
• Evaluate the health resources, services, and systems of
care within the community
• Assess attitudes toward community health services
and issues
• Identify priorities, establish goals, and determine
courses of action to improve the health status of the
community
• Establish an epidemiologic baseline for measuring
improvement over time.

45. Practical relevance of
community diagnosis
• - to act as a data reference for the district
• - to provide an overall picture of the local community and the
residents’ concerns
• - to suggest priority areas for intervention and the feasible
solutions
• - to indicate the resource allocation and the direction of work
plans
• - to create opportunities for intersectoral collaboration and
media involvement

46. How is the community
diagnosed?

47. Methods of community
diagnosis
The process of community diagnosis involves four stages:
• 1. Initiation
• 2. Data collection and analysis
• 3. Diagnosis
• 4. Dissemination

48. Initiation
1.Committee should be evolved
• Government departments,
• Health professionals and
• Non-governmental organisations.
2.Identify the available budget and resources
3.Conduct a working schedule

49. Data collection and analysis
1.Quantitative and qualitative data has to be collected
• Community surveys
• Face to face questionaries'/interviews
• Focus groups
2. An experienced organisation has to be involved
3. Sample size should be large enough to provide sufficient data to
draw reliable conclusions

50. Contd..,
• Collected data can then be analysed and interpreted by experts
• Eg. statistical information is best presented as rates or ratios for
comparison
• local district data can be compared with other districts or the
whole population
• graphical presentation is preferred for easy understanding

51. Diagnosis
It should preferably comprise three areas:
• - health status of the community
• - determinants of health in the community
• - potential for healthy city development
•

52. Dissemination
• The report can be disseminated through the following
channels:
• - Presentations at meetings of the health boards and
committees,
• - Press release - thematic events (such as health fairs and
other health promotion programmes)

53. SCOPE OF COMMUNITY
HEALTH NURSING
Community
Health
Nursing
Industrial
Nursing
Family
Nursing
Occupational
Nursing
MCH
School
health
Nursing
Forensic
Nursing
Home
care
Nursing

54. BASIC INDICATORS
Under-5 mortality rank 49
Under-5 mortality rate (U5MR), 2012 56
U5MR by sex 2012, female 59
Infant mortality rate (under 1), 2012 44
Total population (thousands) 2012 1236686.7
Annual no. of under-5 deaths (thousands) 2012 1414
Life expectancy at birth (years) 2012 66.2

55. CONCLUSION
It is important to realise that Community Diagnosis is not an one-
off project, but is part of a dynamic process leading to health
promotion in the community. Therefore community diagnosis
should be conducted at regular intervals to allow the HCP be
continuously improved.