Department of Community Medicine

1. 1

2. INDICATORS OF HEALTH
2
• Indicators also termed as Index or Variable is only
an indication of a given situation or a reflection
of that situation.
• Health indicator is a variable, susceptible to direct
measurement, that reflects the state of health of
persons in a community.
• Indicators help to measure the extent to which
the objectives and targets of a programme are
being attained.

3. WHAT IS THE NEED FOR HEALTH
INDICATORS?
• Health indicators are required to know the health
status of a community.
• It also help us to-
 to compare health status of one country
with that of other.
 for assessment of health care need.
 for allocation of scarce resources.
 for monitoring and evaluation of health services;
activities; and programme.
3

4. 4
Health status
indicator
Measure different
aspect of health of a
population.
Ex:-life expectancy
Infant mortality
Disability
Chronic disease rates
Health
determinant
indicator
Measures things
that influence
health.
Ex:-diet
Smoking
Water quality
Income
Access to health sevices

5. Characteristics of Indicators
valid
specific
reliable
feasible
sensitive
relevant
5

6. USES OF INDICATORS
Measurement Description Comparisons
Identification of
health needs and
prioritizing them.
Evaluation of
health services
Planning and
allocation of
health resources.
Measurement of
health success
6

7. CLASSIFICATION OF INDICATORS
MORTALITY INDICATORS
MORBIDITY INDICATORS
DISABILITY RATES
NUTRITIONAL STATUS INDICATORS
HEALTH CARE DELIVERY INDICATORS
UTILIZATION INDICATORS
7

8. CLASSIFICATION OF INDICATORS
INDICATORS OF SOCIAL AND MENTAL HEALTH
ENVIRONMENTAL INDICATORS
SOCIO-ECONOMIC INDICATORS
HEALTH POLICY INDICATORS
INDICATORS OF QUALITY OF LIFE
OTHER INDICATORS
8

9. MORTALITY INDICATORS
9
• Crude Death Rate:- No. of death per 1000
population per year in a given community.
crude death rate is 6.9 in India ( SRS
2016)
• Expectation of life:- Average no. of years
that will be lived by those born alive into a
population if the current age-specific
mortality rates persist.

10. 10
• Age specific death rates:- It is defined as
total no. of deaths occurring in a specific age
group of the population in a defined area
during a specific period per 1000 estimated
population of the same age group of a
population in the same area during same
period.
• Infant mortality rate:- Infant Mortality Rate
is the ratio of deaths under 1 year to the total
number of live births in the same year;
usually expressed as a rate per 1000 live
birth.
IMR is 34.0 in India (SRS 2016)

11. 11
• Child Death Rate:- It is defined as the number of
deaths at age 1-4 yr in a given year, per 1000
children in that age group at the mid-point of the
year concerned.
• Under -5 proportionate mortality rate:- It is the
proportion of the total deaths occurring in the
under-5 age group.
Under-5 mortality rate in India is 47.7(2015)
• Adult mortality rate:- It is defined as probability
of dying between the age of 15 and 60 years per
1000 population.

12. 12
• Maternal mortality rate:- It is defined as annual
no. of female deaths per 100000 live births from
any cause related to or aggravated by pregnancy
or its management.
MMR in India is 174 (SRS 2015)
• Disease specific mortality rate:- Mortality rates
can be computed for specific diseases.
• Proportion mortality rate:- The simplest measure
of estimating the burden of a disease in the
community is proportional mortality rate,i.e;the
proportion of all deaths currently attributed to it.

13. 13
• Case fatality rate:- Case fatality rate is
calculated as number of deaths from a specific
disease during a specific time period divided
by number of cases of the disease during the
same time period, usually expressed as per
100.
Ex:-Case fatality rate of dengue is 0.33%
(2014)

14. MORBIDITY INDICATORS
• Morbidity indicators reveal the burden of ill
health in a community, but do not measure
the subclinical or inapparent disease states.
1) INCIDENCE:
The number of new cases or new events of a
disease in a defined population, within a
specified period of time.
Ex:-The incidence of tuberculosis in India is
167 per 1 lakh population per year (2014)
14

15. 2) PREVALENCE:
• The total number of all individuals who have
an attribute or disease at a particular time
divided by population at risk of having
attribute or disease at this point of time.
• Reflects the chronicity of the disease.
• Ex:-The prevalence of tuberculosis in India is
195 per 1 lakh population per year (2014)
15

16. 3) NOTIFICATION RATES is calculated from the
reporting to public authorities of certain
diseases.
Ex:- Yellow fever, poliomyelitis
They provide information regarding
geographic clustering of infections, quality of
reporting system etc.
4) ATTENDANCE RATES at OPDs and at health
centers.
5) ADMISSION, READMISSION AND DISCHARGE
RATES.
16

17. DISABILITY RATES
Disability rates are of two categories:
EVENT TYPE
INDICATORS
-No. of days of
restricted activity.
-bed disability
days
-work-loss days
within a specified
period.
PERSON TYPE
INDICATORS
-limitation of mobility
Ex-confined to bed
Confined to house
-limitation of activity
Ex-limitation to perfom
the basic activites of
daily living(ADL).
17

18. DISABILITY RATES
18
• SULLIVAN’S INDEX: refers to “expectation of
life free of disability.”
• Sullivan’s Index= life expectancy of the
country-probable duration of bed disability
and inability to perform major activities.
• It is considered as one of the most advanced
indicators currently available.

19. DISABILITY RATES
19
• HALE is Health Adjusted Life Expectancy
 Based on the framework of WHO’s ICIDH
(International Classification of Impairments,
Disabilities, and Handicaps)
 Based on life expectancy at birth but includes
an adjustment for time spent in poor health.
It is the equivalent no. of years in full health
that a newborn can expect to live based on
current rates of ill-health and mortality.

20. DISABILITY RATES
20
• DALY’s: Disability Adjusted Life Years.
 It is defined as the no. of years of healthy life
lost due to all causes whether from premature
mortality or disability.
 It is the simplest and the most commonly
used measure to find the burden of illness in a
defined population and the effectiveness of
the interventions.

21. DISABILITY RATES
21
• Two thing needed to measure DALY’s are-
 Life table of that country, to measure the
losses from premature deaths.
 Loss of healthy life years resulting from
disability; the disability may be permanent
(polio) or temporary (TB,leprosy),physical or
mental.
 DALY = years of life lost +years lost of
disability

22. DISABILITY RATES
22
Uses of DALYs
1) To assist in selecting health services priorities.
2) To identify the disadvantaged groups.
3) Targeting health interventions.
4) Measuring the results of health interventions.
5) Providing comparable measures for planning and evaluating
programme.
6) To compare the health status of different countries

23. DISABILITY RATES
23
• QALY’s : Quality Adjusted Life Expectancy
 It is the most commonly used to measure the
cost effectiveness of health interventions.
 It estimates the no. of years of life added by a
successful treatment or adjustment for quality
of life.
 Each year in perfect health is assigned a value
of 1.0 down to a value of 0.0 for death.

24. NUTRITIONAL STATUS INDICATOR
24
• Nutritional status is a positive health indicator.
• Newborn are measured for their-
1)Birth weight 2)length 3) head circumference
They reflect the maternal nutritional status.
• Anthropometric measurements of pre-school
children.
1)Weight- measures acute malnutrition
2)Height- measures chronic malnutrition
3)Mid- arm circumference- measures chronic
malnutrition

25. NUTRITIONAL STATUS INDICATOR
25
• Underweight: weight for age <-2SD of the
WHO Child Growth Standard median.
• Stunting: height for age < -2SD of the WHO
Child Growth Standard median
• Wasting: weight for height< -2SD of the WHO
Child Growth Standard median
• Overweight: weight for height < -2SD of the
WHO Child Growth Standard median

26. NUTRITIONAL STATUS INDICATOR
26
• Growth monitoring of children is done by
measuring weight for age , height-for-age,
weight-for-age, head and chest circumference
and mid-arm circumference.
• In adults Underweight, Obesity and Anemia
are generally considered reliable nutritional
indicators.

27. UTILISATION RATES
27
• Utilization rates or actual rates is expressed the
proportional of people in need of a service who
actually receive it in given period, usually a year.
• It depends on availability and accessibility of
health services and the attitude of an individual
towards health care system.
• They direct attention towards discharge of social
responsibility for the organization in delivery of
services.

28. UTILISATION RATES
28
• EXAMPLES-
 Proportion of infants who are fully
immunized -43% (NFHS-3)
 Proportion of pregnant women who receive
ANC care or have institutional deliveries
 Percentage of population who adopt family
planning
BED Occupancy ratio, bed turnover ratio etc.

29. INDICATORS OF SOCIAL AND MENTAL
HEALTH
29
• These includes rates of suicide,homicide,other
crime, road traffic accident, juvenile delinquency,
alcohol and substance abuse, domestic violence,
battered-baby syndrome etc.
• These indicators provide a guide to social action
for improving the health of people.
• Social and mental health of the children depend
on their parents
• Example-substance abuse in orphan children

30. ENVIRONMENTAL INDICATORS
30
• These reflect the quality of physical and biological
environment in which diseases occur and people live.
• The most important are those measuring the
proportion of population having access to safe
drinking water and sanitation facilities.
• These indicators explain the prevalence of
communicable diseases in a community.
• The other indicators are those measuring the
pollution of air, water radiations, noise pollution,
exposure to toxic substances in food and water.

31. HEALTH POLICY INDICATORS
31
• The single most important indicator of political
commitment is allocation of adequate resources.
• The relevant indicators are-
 proportion of GNP (gross national product) spent
on health services.
 proportion of GNP spent on health related
activities like water supply, sanitation, housing
and nutrition.
Proportion of total health resources devoted to
primary health care.

32. INDICATORS OF QUALITY OF LIFE
32
• Life expectancy is now less important.
• The quality of life has gained importance.
• Physical Quality of Life Index
 It consolidates infant mortality, life expectancy at age 1
yr, and literacy.
 for each component the performance of individual
country is placed of 1 to 100.
 the composite index is calculated by averaging the
three indicators giving equal weight to each of them.
 the result is placed on the 0 to 100 scale.
 the PQLI does not consider the GNP.

33. SOCIO-ECONOMIC INDICATORS
33
• These indicators do not directly measure health.
Nevertheless, they are of great importance in the
interpretation of the indicators of health care.
These includes—
1) Rate of population increase
2) Per capita GNP
3) Level of unemployment
4) Dependency ratio
5) Literacy rates, especially female literacy rates
6) Family size
7) housing; the number of persons per room, and
8) Per capita “calorie” availability.

34. OTHER INDICATORS
34
• SOCIAL INDICATORS: UN Statistical Office
• POPULATION • WELFARE SERVICES
• FAMILY FORMATION • HEALTH SERVICES
• FAMILIES AND HOUSEHOLD
LEARNING
• NUTRITION
• EARNING ACTIVITES • HOUSING AND ITS ENVIRONMENT
• DISTRIBUTION OF INCOME • PUBLIC ORDER AND SAFETY
• CONSUMPTION AND
ACCUMULATION OF INCOME
• TIME USE; LEISURE AND CULTURE
• SOCIAL SECURITY • SOCIAL STRATIFICATION

35. 35
• “HEALTH FOR ALL” INDICATORS:
For monitoring progress towards the goal of health
for all by 2000AD ,the WHO listed the following four
categories of indicators.
1) HEALTH POLICY INDICATORS 2) SOCIAL AND ECONOMIC
INDICATORS
• Political commitment to “Health For All” • rate of population increase
• Resource allocation •GNP and GDP
• the degree of equity of distribution of
health services
• Income distribution
• community involvement • work condition
• organizational framework and managerial
process
• adult literacy rate
• housing
•Food availability

36. 36
3) Indicators for the provision
of health care
4) Health status indicators
• availability • low birth weight
• accessibility • infant mortality rate
• utilization • child mortality rate
• quality of care • life expectancy at birth
• maternal mortality rate
• disease specific mortality
• morbidity- incidence and
prevalence

37. 37
• MILLENNIUM DEVELOPMENT GOALS-
INDICATORS:

38. 38
• GOAL:1. Eradicate extreme poverty and
hunger.
INDICATOR:
4. Prevalence of underweight children
under five of age.
5. proportion of population below minimum
level of dietary energy consumption.
• GOAL:4. Reduce child mortality.
INDICATOR:
13. Under 5 mortality rate
14. Infant mortality rate

39. • GOAL:5. Improve maternal health
16. Maternal mortality ratio
17. Proportional of birth attended by skilled
health personnel
• GOAL:6. Combat HIV/AIDS, malaria and other
diseases
18. HIV prevalence among young people aged
15 to 24 years
19. Condom use rate of the contraceptive
prevalence rate
20. Number of children orphaned by HIV/AIDS
39

40. 21. Prevalence and death rates associated with
malaria.
22. Proportion of population in malaria risk areas
using effective malaria prevention and treatment
measures
23. Prevalence and death rates associated with
tuberculosis.
24. Proportion of tuberculosis cases detected and
cured under DOTS
GOAL: 7. Ensure environmental sustainability
29. Proportion of population using solid fuel
30. Proportion of population with sustainable
access to an improved water source, urban and
rural
40

41. • GOAL:8 DEVELOP A GLOBAL PARTNERSHIP
FOR DEVELOPMENT
Indicator:46. Proportion of population with
access to affordable essential drugs on a
sustainable basis.
41

42. REFERENCES
42
• K. Park , Park’s Textbook Of Preventive And
Social Medicine, M/S Banarsidas Bhanot
Publishers, 25th Edition,2019
• AM Kadri, IAPSM’s Textbook Of Community
Medicine, Jaypee Brothers Medical Publishers,
1st Edition. 2019
• Roger Detels Et Al, Oxford Textbook Of Global
Public Health, Oxford, 6th Edition

43. 43