Understanding Health Indicators: Importance & Types

What are Health Indicators?

Variables that reflect a community's health characteristics/status are known as health indicators.

Why Do We Need Health Care Indicators?

• Reflect the health status of a community.
• Compare the health status of different communities.
• Assess the health care needs of the community.
• Allocate resources.
• Monitor and evaluate health care services.
• Monitor whether the objectives/target of a program are being achieved.

What Is The Difference Between A Health Indicator And A Health Index?

Health Indicator: A variable which reflects change

Health Index: An amalgamation of indicators

What Are The Characteristics Of Health Indicators?

Valid: Measure what they are supposed to measure.

Sensitive: Sensitive to the changes in the situation

Specific: Reflect only the changes in the situation concerned.

Reliable, repeatable, replicable/reproductive: Answers should be the same if measured under different observers under similar circumstances

Relevant: Contribute to the understanding of the phenomenon of interest.

Feasible: The data needed should be feasible or obtainable.

Explain the types of Health indicators

• Indicators of quality of life
• Mortality indicators
• Morbidity indicators
• Health policy indicators
• Socio-economic indicators
• Environmental indicator
• Indicators of social and mental health
• Health care utilization indicators
• Disability indicators
• Nutritional status indicators
• Health care delivery indicators

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Mortality indicator

Starting point of the health evaluation of a community.

Crude Death Rate

• (Total no. of deaths in a community/MYP (mid-year population) in the same area) ´100.
• Mid-year population is taken in July.
• It indicates the rate at which people are dying.
• Limitation does not consider the age and sex of the population.

Age-Specific Death Rate

ASDR = (total no. of deaths in a particular age group (e.g., 20-24 years) in a given area in a year/MYP of the age group in the same area and year) * 1000.

Expectation of Life

• Life expectancy at birth: A positive mortality indicator.
• Average number of years a newborn is expected to live, considering the current age-specific mortality rates in a community.
• Important to calculate the Human Development Index (HDI).
• Life expectancy at one year is PQLI.

IMR: Infant Mortality Rate

IMR = (total no. of deaths (0-1-year-old) in a given year / total number of live births in the same year) * 1000. Important health indicator for the health status of a population.

U5MR: Under-Five Mortality Rate

• U5MR = (total no. of deaths (0–5 years old) in a given year / total number of live births in one year)*1000.
• Important indicator for health status and socio-economic development of a country.

Maternal Mortality Rate (MMR)

• (MMR) = (total no. of maternal deaths/women in the reproductive age group [15-49 years]) * 100000.
• Maternal Mortality Ratio (MMR) = (total no. of maternal deaths/life births) * 100000.
• Maternal deaths: deaths during the antenatal period, delivery, or within six weeks of the postnatal period, excluding accidental or incidental causes.
• Pregnant women who died from electric shock don't count as maternal deaths.

Adult Mortality Rate

• Probability of dying between 15 and 60 years of life.

Year of Potential Life Lost

• Premature death
• E.g., arbitrary cut-off: a person should survive up to 75 years. But the person dies at 30 years. 45 years of potential life lost.

Proportional Mortality Rate

• The simplest measure of a burden of a disease
• (Total deaths due to disease 'x'/ Total deaths in a community)*100

Case Fatality Rate

• How severe is the disease?
• CFR = (Deaths due to diseases 'x' / total number of cases of disease 'x') * 100

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Morbidity Indicators

• Morbidity means spells of sickness or illness due to disease.
• E.g.: Mental illness, Rheumatoid arthritis
• Supplements mortality statistics

Types of Morbidity Indicators

• Incidence and prevalence of disease
• Spells of sickness due to disease
• Duration of stay in a hospital
• Admission/readmission and discharge rates
• Attendance rate at OPD
• Notification rate

Drawbacks of Morbidity Indicators

Ignore the inapparent or subclinical infection.

Disability Indicators

Disability rates: Any restriction or lack of ability to perform an activity

Types of disability indicators

Event Type Disability Indicator

• E.g., number of days restricted to bed due to sickness
• Bed disability rates
• Work/school days lost within a specified period

Person-Type Disability Indicator

• Limitation of mobility—confined to bed
• Limitation of activity—not able to perform activities.

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DALY

Disability-Adjusted Life Year

• DALY: Years of life lost to premature death + years live with disability
• 1 DALY: 1 year of healthy life lost
• It is a measure of the burden of disease and effectiveness of intervention

Year of Life Lost (YLL)

• The number of deaths at each age x the expected remaining years of life according to a global standard life expectancy.
• The global standard life expectancy of Japan is 85 years.

Years Lost To Disability (YLD)

• The number of incident cases due to injury and illness x the average duration of the disease and a weighting factor reflecting the severity of disease on a scale from 0 (perfect health) to 1 (dead).

HALE

Healthy Life Expectancy

• HALE = Life Expectancy at birth + adjustment of time spent in poor health

Life Expectancy

• Average number of years a newborn is expected to live considering the current age-specific mortality rate.

HALE (Health Adjusted Life Expectancy)

• Average number of years a newborn is expected to live in full health considering the current age-specific mortality rate.

QALY

Quality-Adjusted Life Years

• Quality and quantity of life lived.
• Assessing the value for money of a medical intervention.
• No. of years of life added due to the intervention.
• QALY: 1 year of life lived in perfect health.
• Score between 0 (death) and 1 (perfect health).

Sullivan's Index

• Advanced disability indicator
• Sullivan's index = LE - Duration of stability
• It is disability - free life expectancy

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Nutritional Indicators

• Prevalence of low birth weight
• Anthropometric measurement of pre-school children
• Height and weight of children at the time of school entry

Health Care Utilization Indicators

• Services being utilized
• Percentage of children fully immunized
• Percentage of eligible couples using family planning methods
• Bed occupancy rates
• Bed turnover ratio
• Average length of stay in hospital

Indicators of social and Mental Health

• Suicide rate
• Mental illness

Health Policy Indicator

• Proportion of GNP (Gross National Product) spent on health: income from abroad.
• GDP: Gross Domestic Product—Income within a country

Health Care Delivery Indicators

• Doctor population ratio
• Doctor-nurse ratio
• Population bed ratio
• Sub Centres
• Trained birth attendance

Environmental Indicators

• A percentage of the population has access to safe water and sanitation.
• Percentage of households have a water source at home or within 15 m of the home.

Socioeconomic Indicators

• Rate of population increase
• Per capita GNP
• Level of unemployment
• Dependency ratio
• Literacy rate
• Family size
• Housing
• Per capita calorie availability

Quality of Life Indicators

• PQLI (Physical Quality of Life Index)
• HDI (Human Development Index)

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Points to Remember 

• Bed occupancy ratio = Average daily inpatient cases / Average number of beds
• Bed turnover ratio = No. of daily discharges / Average no. of beds
• Basic Needs Indicator : Given by ILO (International Labor Organization)

Important questions?

Q. One DALY Signifies?

A. 1 lost year of healthy life

Q. The Following Indicator Is Not An Event Type Indicator Of Disability:

A. Number of days restricted activity

B. Bed disability days

C. Limitation to perform the basic activities of daily living

D. School loss days

Q. Health Indicators Characteristics Include All Except

A. Validity

B. Reliability

C. Affordability

D. Feasibility

Q. Health Indicators Are Used For

A. Health status of community

B. Requirement of health needs

C. Assess the rate of infection

D. To meet basic needs

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