This document discusses health indicators which are variables that can be directly measured to reflect the health status of a community. Good health indicators are valid, reliable, sensitive, specific and feasible. They are used to measure, describe and compare community health, identify health needs, plan health resources, and measure health successes. Examples of common health indicators discussed are mortality rates, morbidity rates, disability rates, and nutritional indicators. Specific indicators described in detail include crude death rate, life expectancy, infant mortality rate, and maternal mortality rate. Challenges with health indicators and ways to improve them are also outlined.

1. PRESENTED BY:
POOJA SANALKUMAR

2. HEALTH INDICATOR is a variable, susceptible
to direct measurement, that reflects the
state of health of the subjects in a
community

3.  VALID
 RELIABLE
 SENSITIVE
 SPECFIC
 FEASIBLE
 RELEVANT

4.  Measurement, Description and Comparison of
the health of the community.
 Identification of health needs & prioritizing
them.
 Planning & allocation of health resources.
 Measurement of health successes.

5. Mortality indicators Indicators of social and
mental health
Morbidity indicators Environmental indicators
Disability rates Socio-economic indicators
Nutritional indicators Health policy indicators
Health care delivery
indicators
Indicators of quality of life
Utilization rates Other indicators

6.  Crude Death Rate
 Expectation Of Life
 Age Specific Death Rate
 Infant Mortality Rate
 Child Mortality Rate
 Under 5 Proportionate Mortality Rate
 Adult Mortality Rate
 Maternal Mortality Rate
 Disease Specific Mortality Rate
 Proportional Mortality Rate
 Case Fatality Rate
 Years Of Potential Life Lost

7.  Number of deaths per 1000 population per
year in a given community.
 Fair indicator of health.
 ↓ death rate – assesses health improvement
in a community the overall.

8.  Life expectancy at birth : the average number
of years that will be lived by those born alive
into a population if the current age-specific
mortality rates persist.
 In India,
◦ Male 63.8
◦ female 67.3

9. 65
80
67
76
68
86
69
81
0
20
40
60
80
100
INDIA JAPAN NEPAL USA
Males Females
Source – K.Park, Fertility, Park’s Textbook of
social and preventive medicine, 2015, 23rd
Edition, M/s Banarsidas Bhanot, India

10. 58 60 66.2 67.2 74 69
0
20
40
60
80
Life Expectancy
Source:
http://populationcommission.nic.in
/content/932_1_TablesMapsAndBar
Charts.aspx , accessed on June 2nd
2015

11.  The ratio of deaths of children under 1 year
of age in a given year to the total number of
live births, in the same year.
 Usually expressed as rate per 1000 live
births.
 Sensitive indicator of availability,
utilisation and effectiveness of
health care, particularly
perinatal care.

12. 54%
16%
4%
4%
2%
3%
17%
Low Birth Weight
Respiratory infections
diarrhoeal disease
congenital
malformations
cord infection
birth injury
unclassified
IN INDIA

13. India Sri Lanka Bangladesh Pakistan US China
1990 88 18 100 106 9 42
2013 41 8 33 69 6 11
0
20
40
60
80
100
120

14. Assam Karnataka Punjab Delhi Kerala
RURAL 58 36 30 36 13
URBAN 33 25 24 23 9
COMBINED 55 32 29 25 12
0
10
20
30
40
50
60
70
Infant Mortality Rates

15.  Improved obstetric and perinatal care
(availabity of oxygen, foetal monitoring
during labour)
 Improvement in quality of life(social and
economic progress)
 Better control of communicable
diseases(immunisation)
 Better nutrition(emphasis on
breast feeding)
 Family planning(birth spacing)

16.  Number of deaths at age of 1-4 years in a
given year, per 1000 children in that age
group at the mid-point of the year.
 Correlates with inadequate MCH services, low
coverage by immunisation & adverse
environmental exposure.

17.  The proportion of total deaths occurring in
the under-5 age group.
 Reflects both infant and child mortality.
 In India, 59/1000
 In China, 18/1000

18.  Number of maternal deaths in a given period
per 100,00 women of reproductive age
during the same time period.
 Accounts for the greatest proportion of
deaths among women of
reproductive age in most
developing countries.

19. 8%
5%
5%
11%
37%
34%
IN INDIA
Abortion
Obstructed labour
Hypersensitive
disorders
Sepsis
Haemorrhage

20. 28 32
170 178
200
0
50
100
150
200
250
US China Pakistan India Myanmar
Maternal Mortality Rate

21. 21.1
8.1 9 3.3
230
144
155
66
0
50
100
150
200
250
MP Karnataka Punjab Kerala
Maternal Mortality Rate/100,00 births
Maternal Mortality Ratio

22.  Estimates the burden of a disease in a
community.
 Example, Coronary heart disease – 25 to 35%
of all deaths in western countries.
 Other Mortality indicators are case fatality
rate and Years Of Potential Life Lost(YPLL).

23.  Extrication of communicable diseases
 Other indicators emerged, like in deaths from
cancers, cardiovascular diseases, accidents,
diabetes, etc.

24.  Incomplete reporting of deaths
 Lack of accuracy (recording age and cause of
death)
 Lack of uniformity and standardised method
of data collection.

25.  Any departure, subjective or objective, from a state
of physiological well being.
 Used to supplement
mortality data to describe
the health status of a
population

26.  Following morbidity rates are used:
◦ Incidence and prevalence
◦ Notification rates
◦ Attendance rate at the O/P dept.
◦ Admission, readmission & discharge dates
◦ Duration of stay in hospital
◦ Spells of sickness/absence from work/school.

27.  Disability is defined as “any restriction or lack
of ability to perform an activity in a manner
or within the range considered normal for a
human being.”
 Types :
(1)Event type indicators
(2)Person type indicators

28. Event-type indicators
Person-type
indicators
 Number of days of
restricted activity
 Bed disability days
 Work-loss days
within a specific
period
 Limitation of
mobility (confined
to bed/ house)
 Limitation of
activity

29.  Based on life expectancy at birth and includes
an adjustment for time spent in poor health.
 It is the equivalent number of years in full
health a new born can expect to live based on
current rates of ill health and mortality.

30.  Used for assessing value for money of
medical intervention
 Values : perfect health = 1.0
death = 0.0
Therefore, 1 QALY=1 year of life x 1 unity
value.

31.  Measure of overall disease burden, expressed
in number of years lost due to ill health or
early death.
 Daly combines: Years of Lost Life (YLL) and
Years Lost to Disability (YDL)
 DALY= YLL + YLD

33.  3 Nutritional Status indicators considered
important are:
◦ Prevalence of low birth weight (2.5 kg)
◦ Height and weight of children at school entry
◦ Anthropometric Measurement of preschool children

34.  Reflects the equity of distribution of health
resources in different parts of the country, and of
provision of health care.
 Frequently used indicators:
◦ Doctor-population ratio
◦ Doctor-nurse ratio
◦ Population-bed ratio
◦ Population per health/sub centre
◦ Population per traditional birth attendant