all the useful indicator in community health assesment

1. INDICATORS
OF
HEALTH
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Presented By:
Narendra Singh
PG JR1
Department of Community Medicine

2. Health
 “A state of complete physical, mental & social
wellbeing, and not merely an absence of disease or
infirmity” (WHO).
 Amplified to include the ability to lead a “socially and
economically productive life”
 Health cannot be measured in exact measurable forms.
 illness (or lack of health), consequences of ill-health
(morbidity, mortality) & economic, occupation &
domestic factors that promote ill health.
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3. Indicators
WHO defines Indicators as:
“variables which measure
change”

4. Indicators of Health
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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.

5. Characteristics
• Valid – actually measure that they are supposed to
measure
• Reliable – results should be the same when measured
by different people in similar circumstances
• Sensitive – sensitive to changes in the situation
concerned
• Specific – reflect changes only in the situation
concerned
• Feasible – have the ability to obtain data when needed
• Relevant – contribute to the understanding of the
phenomenon of interest
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6. Classification of Indicators of
Health
 Mortality Indicators
 Morbidity Indicators
 Disability Rates
 Nutritional Indicators
 Health Care Delivery
Indicators
 Utilization Rates
 Indicators of Social And
Mental Health
 Environmental Indicators
 Socio-economic Indicators
 Health Policy Indicators
 Indicators of Quality of
Life
 Other Indicators
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7. Mortality Indicators
 Crude Death Rate
 Age Specific Death Rates
 Expectation of life
 Infant mortality rate
 Under-5 Proportionate Mortality rate
 Child Mortality Rate
 Maternal Mortality Rate
 Disease Specific Death Rate
 Proportional Mortality Rate
 Case fatality rate
 Year of potential life lost
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Birth rate 21.6/1000 live birth
Crude death rate(SRS 2012) 7/1000 live birth
Infant mortaility rate(SRS 2012) 42/1000 live birth
Maternal mortality ratio(2012) 178/100000 live birth
Expectation of life at birth
( census2011)
Male: 67.3 female: 69.6

9. Year of potential life
lost
Year of life lost through premature death.
Death which occurs before the age to which a
dying person could have expected to survive (75
yrs).
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16. Morbidity Indicators
Incidence
 Number of new events or cases occurring in a defined
population, during a specified period of time.
 Ex: Incidence of TB (new sputum+ve cases) is 168 per
100000 population per year.
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 or midway through the period.
 Ex: Prevalence of TB (sputum+ve in population) is 249
per 100000 population .
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17. Morbidity Indicators
1. Notification rate
2. Attendance rates at OPDs and at health centers.
3. Admission, Readmission and discharge rates.
4. Duration of stay in hospital
5. Spells of sickness or absence from work or
school.
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18. Disability Rates
Disability Rates are of two categories
 Event type Indicators
- number of days of restricted activity
- bed disability days
- work-loss days within a specified period
 Person type Indicators
- limitation of mobility
- limitation of activity: basic activity of daily living
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19. Disability Rates
HALE (Health Adjusted Life Expectancy)
1. life expectancy at birth but includes an adjustment for
time spent in poor health.
•Number of years in full health that a newborn can expect
to live based on current rates of ill-health and mortality.
•HALE FOR INDIA IS 53 YEARS.
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20. QALY(Quality Adjusted Life Year)
 Commonly used to measure the cost
effectiveness of health interventions .
 Number 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 down to a value of 0 for death.
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21. Disability Rates
DALY (Disability Adjusted Life Years)
Number of years of healthy life lost due to all causes whether from
premature mortality or disability.
MAJOR MEASURES USED ARE:( DALY = YLL+ YLD)
1. YEAR OF LIFE LOST: no of death at each age multiplied
by the expected remaining years of life a/c to a global
standard life expectancy.
2. Years lost to disability: no of incident cases due to injury
and illness is multiplied by the average duration of
disease and a weighing factor reflecting the severity of
disease on a scale from 0 (perfect health) and 1(dead).
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22. Nutritional Status Indicators
 Positive health indicator
Anthropometric measurements
of pre-school children
i. Weight
ii. Height
iii. Mid-arm circumference
 Growth Monitoring of
children
 Prevalence of low
birth weight
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23. Health Care Delivery Indicators
 Equity of distribution of health resources in different
parts of the country and of the provision of health
care
 Doctor-population Ratio – 1/1700 (Norm 1/1000)
 Nurse-population ratio – 0.8/1000 (Norm 1/500)
 Doctor- nurse ratio
 Population-bed Ratio – 8.9/10000
 Population per PHC/sub center
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The present doctor-population ratio is 0.5 per 1,000 and the target
by 2025 is 0.8 per 1,000.
Total medical colleges:387
181 government
206 private sector.
India produces 30,000 doctors, 18,000 specialists, 30,000
AYUSH graduates, 54,000 nurses, 15,000 ANMs and 36,000
pharmacists annually.
Health ministry claims that there are about 6-6.5 lakh doctors
available. But India would need about four lakh more by 2020 to
maintain the required ratio of one doctor per 1,000 people.

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26. UTILIZATION RATES
 Actual coverage is expressed as the proportion of
people in need of a service who actually receive it in a
given period, usually a year.
• Depends on availability & accessibility of health
services and the attitude of an individual towards health
care system
• Direct attention towards discharge of social
responsibility for the organization in delivery of services
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27. Indicators of Social and Mental
Health
 Valid positive indicator are scarce, so we use indirect
measures viz indicators of social and mental pathology.
 Suicide, homicide, road traffic accident, juvenile
delinquency, alcohol and substance abuse, domestic
violence.
 Guide to social action for improving the health of
people.
Total no murder in 2013: 33201
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32. Environmental Indicators
 Reflect quality of physical and biological
environment in which diseases occur and people
live.
 most important: that measuring the proportion of
population having access to safe drinking water
and sanitation facilities.
 explains the prevalence of communicable diseases
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36. Socioeconomic
Indicators
Rate of growth of population
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INDIAN DECADAL (2001 – 2011) 17.64%
INDIAN ANNUAL GROWTH 1.344%
PER CAPITA GNP Rs 54835/person
Dependency ratio 52
Literacy rates M: 82% F:65% T:74%
Family size
Housing
Per capita calorie available

37. Unemployme
nt rate for
India: 8.8%
for 2014
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39. Health Policy Indicators
 Single most important indicator of political
commitment is allocation of adequate resources.EX:
 Proportion of GNP spent on health services- 8.7%
 Proportion of GNP spent on health related activities like
water supply and sanitation & housing and nutrition-8.5%
 Proportion of total health resources devoted primary
health care.
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40. Indicators of Quality of Life
Physical Quality of Life Index
It consolidates:
1.Infant mortality,
2.life expectancy at age of 1yr
3.literacy.
For each component the performance of individual
country is placed on a scale of 1 to 100.
Composite index is calculated by averaging the three
indicators giving equal weight to each of them.
 Does not consider the GNP.
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41. Human Development Index
composite index combining indicators representing 3
dimensions:
i.longevity( life expectancy at birth)
ii.knowledge (mean years of schooling and expected years
of schooling)
iii.income (real GDP per capita in purchasing power parity
in US dollars).
Index= ( Actual value) –(minimum value)
(Maximum value )– (minimum value)
Placed on the 0 to 1 scale
HDI for India 0.586
HDI ranking of India is 135
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Multidimensional Poverty Index (MPI)
India : 0.251 (2006)
Reflects both the incidence or headcount ratio (H) of
poverty – the proportion of the population that is
multidimensionally poor – and the average intensity (A)
of their poverty – the average proportion of indicators in
which poor people are deprived.
Identified as poor if he or she is deprived in at least one
third of the weighted indicators.
MPI poor are deprived in at least 33% of weighted
indicators.

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"Vulnerable to Poverty" are deprived in 20% - 33% of
weighted indicators.
"Severe Poverty" are deprived in over 50%.

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49. Other Indicators Series
 Health For All Indicators
 For monitoring the progress towards the goal of Health For All
by 2000 , the WHO has listed the following four categories of
indicators.
1. Health policy indicators
 Political commitment to HFA
 Resource allocation
 Degree of equity of distribution of health services
 Community involvement
 Organizational framework and managerial process
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50. contd……
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2. Social and economic
indicators related to
health
• Rate of population growth
• GNP or GDP
• Income distribution
• Work conditions
• Adult literacy rate
• Housing
• Food availability
3. Indicators for the
provision of health care
• Availability
• Accessibility
• Utilisation
• Quality of care

51. contd….
4. Health status indicators
 Low birth weight
 Nutritional status and psychosocial development of
children
 Infant mortality
 Child mortality rate (1-4yrs)
 Life expectancy at birth
 Maternal mortality rate
 Disease specific mortality
 Morbidity – incidence and prevalence
 Disability prevalence
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52. Millennium Development Goals
Indicators related to health:
G1 – T2; halve between 1990 and 2015 the proportion of people who
suffer from hunger.
T2.I4; prevalence of underweight children (below 5yrs) from 53.4 ( 90 )
to 43.5 in 2011
T2.I5; proportion of population below minimum level of dietary of energy
consumption from 25 in 1991 to 15 by 2006.
G4 – T5.I13; under-5 mortality to be reduced from 112 in 1990 to 59 in
2010.
T5.I14; infant mortality rate from 80 in1990 to 47 in 2010.
T5.I15; proportion of 1yr old children immunized for measles of 74 in
2010.
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53. Millennium Development Goals
G5 – T6; reduce maternal mortality by ¾ by 2015.
T6.116; reduce MMR from 212 by 2009.
T6.117; proportion of births attended by skilled health professional of
58 by 2011.
G6 – Combat HIV/AIDS, malaria and other diseases.
Half or halted by 2015 and began to reverse the spread
- reduce HIV prevalence among young people (15 – 49: 2009 = 0.3)
- malaria death rate to be reduced (2011: 0.38 per lakh)
- reduce TB death rate (2010: 23/lakh
- reduce TB prevalence to (2011: 256)
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54. G7 – Ensure environmental sustainability
- reduce proportion of pop using biomass fuel
to 60 by 2007
G7- T10: Half by 2015 the proportion of people
without sustainable access to safe drinking water
rural area: 86
G8: develop a global partnership for development
Ind:48 proportion of population with access to
affordable essential drug on a sustainable basis.
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55. Summary
 Health not measured directly but using
indicators
 Indicator should be valid, sensitive, specific,
reliable, relevant and feasible
 Used in measuring, describing, comparing,
identifying health needs and planning and
evaluation of health services
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