Dr. Surya B. Parajuli gave a lecture on health indicators at the Christian Medical College in Vellore, India. The lecture covered the background and objectives of studying health indicators, definitions of health and indicators, characteristics of good indicators, and examples of common indicators used to measure health such as mortality rates, life expectancy, and rates of disease. The document discussed conceptual frameworks for indicators, how indicators are used to monitor health and support planning, and examples of reports and organizations that compile health data internationally such as the WHO, UNICEF, and national governments.

1. Dr. Surya B. Parajuli
MBBS(KU), MD(BPKIHS), MARD(TU)
Principles and practice of Epidemiology course (Christian medical college, Vellore)
Health Advocate, Dengue researcher, Snake bite Instructor
11/24/2016

2. Teaching Learning Method: Lecture
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Content
Background/objective of study
What is Health
Indicator
Characteristics of Indicator
Quality & quantitative indicator Vs Development of Country
Spectrum of Health
Tools of measurements
Types of indicators
Sullivan’s index
DALY
HFA
UN/ILO
MDG
SDG
Recent trends of indicators
References
Topic: Health Indicator

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Background/Objectives of study
Understand the variety of health indicators,
their data sources, their key attributes, context
and use
Describe health indicators
Common health indicators and data sources
How are health indicators used and compiled?
Examples of reports and on-line tools

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6. What is Health?
By far, the most accepted definition is that of the
World Health Organization:
“[Health is] the state of complete physical, mental and social
well-being and not merely the absence of disease or infirmity”
(WHO, 1948) and the “extent to which an individual or group
is able to realize aspirations and satisfy needs, and to change
or cope with the environment. Health is a resource for
everyday life, not the objective of living; it is a positive
concept, emphasizing social and personal resources as well as
physical capabilities” (WHO, 1984).
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7. What are Health Indicators? (1)
With the goal of good health in mind, think of
an indicator as
“…a measure that helps quantify the
achievement of a goal.”
-Mark Friedman
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8. What are Health Indicators? (2)
Power of indicators is comparisons
- over time (trends)
- geographic areas
- groups of people
and the focus on the most essential domains of
health.
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9. Terminology concept
Indicator also known as Variable
Amalgamation of health indicators= Health
Index
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10. Characteristics of Indicators
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1.Valid
2.Reliable
3.Sensitive
4.Specific
5.Feasible
6.Relevant

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13. Comprehensive Indicator Systems
• Focus on overall Quality of Life with
health being one of many components
(e.g., economy, health, education)
• Example
Sullivan's Index
DALY
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14. Spectrum of Health
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Positive Health
Better Health
Freedom from sickness
Unrecognized sickness
Mild sickness
Severe sickness
Death

15. Rate: a/a+b… time specification…. multiplier
CDR=death/pop X1000 Population…in 1 year
Ratio: a/b…male/female
Proportion: a/a+b X 100 …..percentage
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Tools of Measurements

16. Framework for Health Indicators
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17. What makes a good indicator?
• Data Power – high quality, available data
• Proxy Power – central importance to health
• Communication Power – that the meaning is
transparent.
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18. What are the bases for health indicators?
Health indicators are based upon conceptual models for what
influences health status, based upon scientific research.
Models have evolved over time, as have definitions of health, but
trace historical improvements in health, e.g., increases in life
expectancy, declines in mortality due to infectious diseases.
Context is important: For example, in 1900 the leading causes of
death were Pneumonia, Tuberculosis, and Diarrhea and Enteritis as
compared to Heart Disease, Cancer, and Stroke in 2006.
Source: MMWR. July 30, 1999 / 48(29);621-629
http://www.cdc.gov/nchs/data/nvsr/nvsr57/nvsr57_14.pdf
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19. Current Conceptual Frameworks
Today’s context:
•Rate of healthcare spending is unsustainable, and, levels of
spending not consistent with level of health. Ripe opportunities for
increasing the return on investments in health through prevention.
•Burden of chronic diseases (e.g., premature mortality, costs) and
•Complex public health problems (e.g., violence, obesity, HIV), and
health-related behaviors (e.g., smoking, diet, substance use)
•The influence of social and environmental conditions on
determining health outcomes, either directly or indirectly
•Deep, persistent disparities in health
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20. Common Frameworks for Health Indicators
1. Broad “Determinants of Health” - emphasizes the
physical environment, social environment, health
behaviors, medical care.
2. “Life Course” - emphasizes conditions/experiences
early in life (e.g., 0-5) and interactions at developmental
stages throughout life in optimizing our health
"trajectory".
3. “Social Determinants” emphasizes educational,
economic, and social conditions and interactions in
shaping health.
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21. How are health indicators used?
Indicators are powerful tools for monitoring and communicating
critical information about population health.
Indicators are used to support planning (identify priorities, develop
and target resources, identify benchmarks) and track progress toward
broad community objectives.
Engagement of partners into civic and collaborative action (build
awareness of problems and trends, generate interventions).
Inform policy and policy makers, and can be used to promote
accountability among governmental and non-governmental agencies.
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22. Who compiles health indicators?
•Reports are compiled at local level
•Regional level - Health departments, businesses,
educational, law enforcement, human services
providers, and other civic leaders, faith
organizations, universities, media.
• National– Government/private partnerships.
• International – WHO, UNICEF
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23. Gaps in Data Sources or Measures
Examples of indicators that lack of systematically
collected and standardized data:
• Early life - developmental outcomes at the time of
primary school and conditions throughout childhood
and youth, e.g., obesity.
• Later life – community care and support, long term
care, quality and availability of services.
• Social environments, e.g., neighborhood
characteristics, quality of social interactions.
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24. Types
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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
HFA, MDG, SDG

25. 1. Mortality indicators
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A.Crude Death Rate
B.Expectation of life
C.Infant mortality rate
D.Child mortality rate
E.Under-5 mortality rate
F. Maternal(puerperal) mortality rate
G.Disease specific mortality rate
H.Proportional mortality rate

26. 2. Morbidity indicators
A. Incidence & Prevalence
B. Notification rates
C. Attendance rates at OPD, health centers
D. Admission, readmission and discharge rates
E. Duration of stay in hospital
F. Spells of sickness or absence from work or
school
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27. 3. Disability Rate
I. Event-type indicators
i. Number of days of restricted activity
ii. Bed disability days
iii. Work loss days (or school loss days) within a
specified period
II. Person-type indicators
i. Limitation of mobility
ii. Limitation of activity
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29. Sullivan’s index
• Expectation of life free of disability
• Considered one of the most advanced indicators
• E.g. the expectation of life at birth for all persons
in the USA in 1965 was 70.2 years, and the
approximate expectation of life free of disability
worked out to be 64.9 years.
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30. HALE
• Health-Adjusted Life Expectancy
• DALE to HALE
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31. DALY: Disability-adjusted life year
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32. 4. Nutritional status indicators
A. Anthropometric measurements of preschool
children, eg weight and Height, MUAC
B. Heights of children at school entry
C. Prevalence of low birth weight
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33. 5. Health care delivery indicators
A. Doctor-population ratio
B. Doctor –nurse ratio
C. Population-bed ratio
D. Population per health/subcentre
E. Population per traditional birth attendant
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34. 6. Utilization rates
• Proportion of infants who are fully immunized
against EPI disease
• Proportion of pregnant women who receive ANC,
or have their deliveries supervised by a Trained
birth attendance
• Percentage of the population using the various
methods of family planning
• Bed-occupancy rate
• Average length of stay
• Bed turn over ratio
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35. 7. Indicators of social and mental
health
• Suicide rate
• Homicide rate
• RTA
• Alcohol and drug abuse
• Smoking
• Consumption of tranquilizers
• Obesity
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36. 8. Environmental indicators
• Pollution of air and water
• Radiation
• Solid waste
• Noise exposure
• Exposure to toxic substance in food or drink
• Proportion of population having access to safe
water
• Sanitation facility
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37. 9. Socio-economic indicators
• Rate of population increase
• Per capita GNP
• Level of unemployment
• Dependency ratio
• Literacy rates
• Family size
• Housing
• Per capita calorie availability
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38. 10. Health policy indicators
• Proportion of GNP spent on health services
• Proportion of GNP spent on health related
activities (including water supply and
sanitation, housing and nutrition, community
development)
• Proportion of total health
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39. Health System Performance Indicators
• Access (additional)
– Trends in health insurance enrollment, range of benefits, exclusions, premiums
– Rural health provider supply, linguistic or cultural barriers to getting care
• Cost
– Total health expenditures
– Health as share of Gross Domestic Product (GDP)
– Prescription drug costs
– Payments to hospitals, facilities
– Comparisons of resources used per patient between hospitals/areas
• Quality of care
– Effective care – receipt of recommended screenings, treatment, readmission
rates.
– Patient Safety – medical error
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40. 11. Indicators of quality of Life
• PQLI (Physical quality of Life Index)
 Infant mortality rate + life expectancy at age 1+
literacy
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41. 12. Others
A. Social indicators:
– Given by United nation statistical office 12in number
B. Basic needs indicators:
– ILO
– Calorie consumption, access to water, life expectancy, deaths
due to diseases, literacy, doctors and nurses per population,
rooms per person, GNP per capita
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42. C. Health for All indicators
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43. D. MDGs
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17 goals and 169 targets
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SDG

45. Some trends of Indicators
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51. • K. Park “Park’s textbook of preventive and social medicine,” 23rd Edition 2016
• Annual report of DoHS, MoHP, Nepal
• NDHS 2011
• NPHS 2011
• WHO report
References/Acknowledgement
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53. Student Questions
Sir,…………………………..………….
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