The Indicators of Health provide a measure for the health status of a Individual, Group, Community or a Country and to compare it with other similar parameters which help us to understand the good and the poorly assessed areas and to allocate more resources to the ill health and also to monitor and re-evaluate whether the ill are progressing towards a healthy status and to understand what all measures need to be done. In other words we understand the objectives and targets of a particular programme being implemented towards the attainment of better health goals.
Indicators are defined as Variables by the World Health Organisation which have a Negative range and a Positive range in probable observations. This gives an idea about how the progress of a particular programme will go and when these indicators are measured periodically and sequentially over time, they can indicate direction and speed of change and can help to compare the health indications of different groups of people, communities or countries.
Characteristics of Indicators :
The Indicators which should be used in an evaluation, should have the following characteristics so that it can be used in a campaign or a survey.
1. An Indicator should be valid and should be able to do the purpose of what it is intended to do
2. An Indicator should be Reliable and Objective. This means that when different people carry out research on a similar experiment they should, more or less arrive at a similar inference using the same indicators.
3. An Indicator should be Sensitive and should respond in variation to the situation concerned.
4. An Indicator should be Specific and should respond only to the variation of the specific situation in concern.
5. An Indicator should be feasible as it should have the functions attached to it which enable data collection concerned to it.
6. An Indicator should be relevant which means that it should be able to aid in understanding the concept in concern. It should either support the Hypothesis or discard the Hypothesis in concern.
Health is a Multi-Dimensional entity and each entity is a complex phenomenon in itself because the each entity is affected by numerous factors of which Some are Known while many are still Unknown.
Thus Health is subjected to the following Factors :
01. Mortality Indicators
02. Morbidity Indicators
03. Disability Rates
04. Nutritional Status Indicators
05. Health Care Delivery Indicators
06. Utilization Rates
07. Indicators of Social and Metal Health
08. Environmental Indicators
09, Socio-Economic Indicators
10. Health Policy Indicators
11. Indicators of Quality of Life
12. Other Indicators
Mortality Indicators and Morbidity Indicators
A. Mortality Indicators
The indicators indicating mortality in a community are :
1. Crude Death Rate
2. Expectation of life
3. Infant Mortality Rate
4. Child Moratality Rate
5. Under-5 Proportional Mortality Rate
6. Maternal (Puerperal) Mortality Rate
7. Disease specific Mortality
8. Proportional Mortality Rate
1. Crude Death Rate:
It is defined as the number of deaths per 1000 population per year in a given community. Here a decrease in death rate indicates better health conditions in the community indicating an overall increase in the health status of the given population, which is in fact a goal of medicine.
2. Expectation of Life:
Life expectancy means the number of years a human being may live, if the age specific and sex specific mortality rates of a population are known. Life expectancy is calculated at birth, at the age of 1 which excludes infant mortality and at the age of 5 which excludes child mortality. Here also, an increase in average life expectancy is considered as an improvement in health status.
3. Infant mortality rate:
It is defined as the ratio of number of deaths under 1 year of age to the total number of live births in the same year, usually expressed as a rate per 1000 live births. This measure is able to infer upon the health status of the infants, also deductively of the whole population and the socio-economic conditions under which the infants and also the whole population lives.
4. Child mortality rate:
It is defined as the ratio of number of deaths of children 1 to 4 years of age per 1000 children in the respective age group at the mid-point of the year concerned for a particular area or community. This ratio indicates the overall health status of the early childhood in a given community and excludes infant mortality.
5. Under 5 proportionate mortality rate:
When both infant mortality and early childhood mortality need to be considered, then these statistics are used where total number of deaths of children under age 5 per 1000 population is considered. This statistical data helps in inferencing upon high birth rates, high child mortality rates and shorter life expectancy.
6. Maternal (puerperal) mortality rate:
The levels of maternal mortality differ from country to country according to its socio-economic conditions and status representing the proportion of deaths of women in reproductive age which is generally higher in the under developed and developing countries. This data has not gained much importance in terms of statistical analysis and inference.
7. Disease-specific mortality:
This statistical analysis can be computed for mortality on account of specific diseases. As communicable diseases are being extricated, other diseases like Cancers, Cardio-vascular diseases, diabetes have emerged as specific disease problems.
8. Proportional mortality rate:
This statistical analysis takes in account the proportion of all deaths from every abouve mentioned analysis attributed to it.
B. Morbidity Indicators
These indicators indicate the burden of diseases and illhealth in a community but have there own limitations as they represent only the clinical cases and are represented as iceberg theory.
The assessing points for illhealth and diseases in a community are :
1. Incidence and Prevalence
2. Notification rates
3. Attendance rates at health services
4. Admission, Re-admission and discharge rates
5. Duration of stay in hospital
6. Spells of sickness or absence from work or school.
C. Disability Rates
These fall into two categories which are namely :
a. Event type indicators:
i. Number od days of restricted activity
ii. Bed disability days
iii. Work loss days
b. Person type indicators:
i. Limitation of mobility
ii. Limitation of activity
D. Nutritional Status Indicators
These are namely :
- Measurements and proportions of pre-school children.
- Heights and sometimes weights of school level children
- The frequency measurement of babies being born under category of low birth weight. In India, Low birth weight is considered when the weight of the new born child is under 2.5 kgs.
E. Health Care Delivery IndicatorsThis indicator shows us the units of health system present in a given physical and geographical area which are imparting health services the data of which is grouped under the following categories:
- Doctor-population ratio
- Doctor-nurse ratio
- Population-bed ratio
- Population per health/subcentre
- Population per traditional birth attendant
F. Utilization RatesThese measures are used to measure the usage of the health services and is measured under the following categories:
- Proportion of infants who have received complete immunization programme.
- Proportion of pregnant women who have received complete ante-natal care
- Percentage of population using or adapted to various procedures under family planning
- Hospital bed occupancy rate
- Average length of stay of a patient at Hospital
The Utilization Rates can differ according to every Geographical area, the climate and the habitat and surrounding environment. The list can also be inclusive of more criteria on the basis of factors involved in the making of the area.G. Social Health, Mental Health, Environmental and Socio-economic Indicators of Health
Positive health is a rarity, now-a-days. Thus, many a times symptoms and clinical presentations related to social and mental pathology are needed to be used. These indicators indicate the socialism in the given area or community.
We also know that every living entity needs a good environment within acceptable limits so that the living entity remains healthy. The same aoolies to Human beings. The factors which affect the Social ad Mental Health are:
- Solid wastes
- Access to safe water etc.
Socio-economic indicators do not directly measure Health but help in interpretation of the indicators of healthH. Health Policy Indicators
This makes them the most important information rearrangement of sympoms in a present society.
I. Other Indicators may include :
- Indicators for quality of Life
- Basic needs indicators
- Health for All Indicators
Dr. Apurva Tamhane
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