This document discusses concepts of health including definitions of health, indicators of health, and classifications of health indicators. It provides details on commonly used indicators such as mortality indicators (e.g. crude death rate, life expectancy), morbidity indicators, disability rates, and nutritional, health care delivery, and social/mental health indicators. It also discusses characteristics and uses of indicators and classifications such as environmental and socioeconomic indicators. Physical quality of life index is introduced as a composite index used to measure health outcomes.

1. Concepts of Health
Nivetha C

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