This document discusses various determinants of health and health indicators. It describes how health is influenced by internal and external environmental factors, as well as genetics, behaviors, and access to health services. It also outlines several common health indicators used to measure factors like life expectancy, mortality rates, immunization coverage, and socioeconomic development. These indicators can help assess population health status, compare countries, and evaluate health programs.

1. Concept of

2. Determinants of Health

3. • Health is multifactorial.
• Many factors have a bearing on Health. The
factors which affect health are called
“Determinants of Health”.
• These factors interact and these interactions
may be health -promoting or deleterious.

4. Determinants of Health

5. Environment
• Defined as the aggregate of all internal and
external conditions and influences affecting
the life and development of an organism,
human behaviour and society.
• Hippocrates first related disease to
environment.
• (Later) Pettenkofer in Germany revived
disease-environment concept.

6. Internal
Environment
External
• Internal environment is constituted by various
organs and systems of the body. Their
harmonious functioning is called “Homeostasis”.
• External environment is constituted by those
things to which man is exposed after conception.
All that which is external to the individual human
host (physical, biological and social components).

7. • Any disturbance either in the internal or
external environment, disturbs the health of
an individual.
• Harmonious environment relationship to man
contributes to an improved state of health.
• Agent Environment Host
• There is an equilibrium between agent, host
and environment, the balance is maintained
and the individual, family and community
enjoys perfect health.

9. Heredity
• The health of the population or an individual
is greatly dependent upon genetic
constitution of populations.
• a number of diseases are now known to be of
genetic origin; (e.g.: chromosomal anomalies,
errors of metabolism, mental retardation,
diabetes).

10. • The "positive health" advocated by WHO
implies that a person should be able to
express as completely as possible the
potentialities of his genetic heritage.
• This is possible only when the person is
allowed to live in healthy relationship with his
environment.
• Health services also have an impact on
hereditary. E.g.- Genetic counselling.

11. Behaviour
• It is composed of our actions, habits, culture,
beliefs, practices (Lifestyles) that have
developed through process of socialisation.
• These are learnt through social interaction
with parents, peer groups, friends and siblings
and through school and mass media.
• Health requires the promotion of healthy
behaviour.

12. Health Services
• Health services purpose is to improve the
health status of population.
• To be effective, the health services must reach
the social periphery, equitably distributed,
accessible at a cost the country and
community can afford and socially acceptable
• Includes promotive, preventive, curative and
rehabilitative services.

14. Health of a community can be assessed through
measurement of existing health status of people.
Such measurements are called health
indicators.
Uses:
• To measure health status of a country.
• To compare the health status of one country with
that of another country.
• To assess the health care needs.
• To plan and implement health care services.
• To evaluate health care services.

15. • At national level there are Six categories
of minimum essential indicators of health.
• These Include:
- Health status Indicators
- Primary Health Care Coverage Indicators
- Demographic Indicators
- Socioeconomic Indicators
- Health Resources Indicators
- Gender Equity Indicators
WHO-SEARO-EHI Unit, December 2004

16. Life expectancy at birth
Total :
Male :
Female :
Healthy life expectancy (HALE) at birth
Total :
Male :
Female :
Infant mortality rate (per 1,000 live births)
Under-five mortality rate (per 1,000 live births)
Total fertility rate (per woman)
Maternal mortality ratio (per 100,000 live births)
Low birth weight newborns (%)
Children with low weight-for-age (%)
Health Status Indicators

17. Infants immunized (%)
DPT3 :
OPV3 :
BCG :
Measles :
Pregnant women immunized with tetanus toxoid (%)
Attended by trained personnel (% of live births)
Pregnant women :
Deliveries :
Women of child bearing age using contraceptives (%)
Population with access to safe drinking water (%)
Population with access to adequate sanitation (%)
Primary Health Care Coverage Indicators

18. Total population
Surface area (thousands of sq km)
Population density (per sq km)
Population growth rate (%)
Crude birth rate (per 1,000 population)
Crude death rate (per 1,000 population)
Urban population (%)
Urban population growth rate (%)
Demographic Indicators

19. Gross National Income (GNI) per capita (US$)
Gross Domestic Product (GDP) per capita growth rate (%)
Average annual change in consumer price index (%)
Human Development Index (HDI)
Dependency ratio:
Total
Old age
Young
Adult literacy rate:
Total
Male
Female
Gross primary school enrolment ratio (%)
Gross secondary school enrolment ratio (%)
Socioeconomic Indicators

20. Total expenditure on health (as % of GDP)
Public share to total health expenditure (%)
Per capita total health expenditure (International dollars)
Physicians per 10,000 population
Hospital beds per 10,000 population
Health Resources Indicators

21. Life expectancy at birth ratio (females as a % of males)
Gender-related development index (GDI)
Gender empowerment measure (GEM)
Ratio of earned income (females as a % of males)
Seats held in parliament (% women)
Professional and technical workers (% women)
Adult literacy ratio (females as a % of males)
Primary school enrolment ratio (females as a % of males)
Secondary school enrolment ratio (females as a % of males)
Gender Equity Indicators

22. Disability rates
• It is the percentage of the population,
unable to perform the routine expected,
daily activities due to injury or illness.
• Used to supplement mortality and
morbidity indicators.
• Based on the premise that health implies a
full range of daily activities.
• Quantifies the seriousness of the disease.

23. Disability-Adjusted Life Year
(DALY)
• DALY is years of life lost to premature
death and years lived with disability
adjusted for the severity of the disability.
• Measure of the burden of disease in a
defined population and the effectiveness
of the interventions.

24. • DALY = YLL + YLD
years of life lost because of premature death
(YLL)
years of life lived with disability (YLD)
• Burden = Mortality + Disability
• one DALY = one lost year of healthy life

25. Uses of DALY
• To assist in setting health service priorities
• To identify disadvantaged groups
• Targeting health interventions
• Measuring the results of health interventions
• To compare the health status of different
countries
• Providing comparable measure for planning
and evaluating programmes

26. Health-Adjusted Life Expectancy
(HALE)
• Previously known as DALE (Disability
adjusted life expectancy).
• Number of years in full health that a
newborn is expected to live based on
current morbidity and mortality.

27. Sullivan's index
• It is an expectation of life free of disability.
• Computed by subtracting from the life
expectancy the probable duration of bed
disability and inability to perform major
activities, according to cross-sectional
data from the population surveys.
• Considered as one of the most advanced
indicators currently available.