faculty of medicine public health (31505291)الصحة العامة

Faculty of Medicine

Public Health (31505291) ة العامالصحة Lecture 2

Indicators and determinants of global health

By

Hatim Jaber MD MPH JBCM PhD

5-6-2017

1

Presentation outline 5-6-2017

Time

Indicators and determinants of global health variations

0800 to 0810

Relationship between socio-economic development and disease patterns in different nations

0810 to 0830

What are the social determinants of health

0830 to 0840

What contribution do income education and other factors make to health

0840 to 0900

2

Determinants of health

bull Many factors combine together to affect the health of individuals and communities

bull Whether people are healthy or not is determined by their circumstances and environment

bull To a large extent factors such as where we live the state of our environment genetics our income and education level and our relationships with friends and family all have considerable impacts on health

bull Access and use of health care services often have less of an impact


bull The social and economic environment

bull The physical environment

bull The personrsquos individual characteristics and behaviors

bull Access to quality health care


bull Poverty Income and social status - higher income and social status are linked to better health The greater the gap between the richest and poorest people the greater the differences in health

bull Social support networks ndash greater support from families friends and communities is linked to better health

bull Education ndash low education levels are linked with poor health more stress and lower self-confidence

bull Gender - Men and women suffer from different types of diseases at different ages

bull Culture customs and traditions and the beliefs of the family and community all affect health


bull Genetics - inheritance plays a part in determining lifespan healthiness and the likelihood of developing certain illnesses

bull Personal behavior and coping skills ndash balanced eating keeping active smoking drinking and how we deal with lifersquos stresses and challenges all affect health

bull Health services - access and use of services that prevent and treat disease influences health


bull Physical environment

- Safe water and clean air healthy workplaces safe houses communities and roads all contribute to good health

- Employment and working conditions ndash people in employment are healthier particularly those who have more control over their working conditions

Determinants of Health

Plus many more factors such as bull Political stability wars and conflicts

bull Natural disasters

bull Human and civil rights

bull Population growth and economic development in the country

bull Urbanization

Examples

bull Malnutrition ndash ndash more susceptible to disease and less likely to

recover bull Cooking with wood and coal ndash

ndash lung diseases bull Poor sanitation ndash

ndash more intestinal infections bull Poverty

ndash commercial sex work and STIs HIVAIDS bull Advertising tobacco and alcohol ndash

ndash addiction and related diseases bull Untrained drivers on unsafe roads-

ndash road traffic accidents

Health Indicators

What is Health Indicators Definitions

variable which help to measure changes directly or

indirectly (WHO 1981)

A statistic which facilitate concise and balanced

judgments about certain condition

With the goal of good health in mind think of an

indicator as

ldquohellipa measure that helps quantify the

achievement of a goalrdquo(Mark Friedman) Health Indicators Part I

Health Indicator is

bull ldquohellipa measure that helps quantify the

achievement of a goalrdquo -Mark Friedman

Power of indicators is comparisons bull Health indicators are essential for comparing health status - over time (trends) - geographic areas - groups of people and the focus on the most essential domains of health

Health Indicators Part I

A good indicator depends on

bull Availability of high quality data

bull Importance in measuring health status

bull Is well understood at the global level and various comparability options are possible


Health indicators are important because bull They are essential for monitoring and reporting data for decision making about population health bullTo inform policy makers to formulate evidence based policies and to promote accountability among governmental and non-governmental agencies bullThey are critical for setting priorities assessing the health status at baseline planning allocating resources and monitoring progress towards better health status goals bull Needed for assessing the health problems and trends to create awareness engage all the stakeholders in collaborative action and design interventions


Important Health Indicators for measurement of Health Status

bull Cause of death

ndash Obtained from death certification but limited because of incomplete coverage

bull Life expectancy at birth

ndash The average number of years a new-borns baby could expect to live if current trends in mortality were to continue for the rest of the new-borns life

bull Maternal mortality rate

ndash The number of women who die as a result of childbirth and pregnancy related complications per 100000 live births in a given year

Infant mortality rate rsaquo The number of deaths in infants under 1 year per 1000

live births for a given year

Neonatal mortality rate rsaquo The number of deaths among infants under 28 days in a

given year per 1000 live births in that year

Under five child mortality rate rsaquo The probability that a new-born will die before reaching

the age of five years expressed as a number per 1000 live births


Types of Health Indicators

Count Number Measure without a denominator

Rate Numerator is part of denominator Frequency of

occurrence of an event during specific time usually

expressed per 1000 population

Ratio Numerator is not included in denominator (sex

ratio)

Index Aggregation of measurement of specific

indicators


Indicators of Health

Global health indicators highlighting the health inequality

Global health indicators are improving

overall in the worldhellip

But not in all places not for all social

groups and not at the same speed

Health inequality

bullThere is a difference between the health status of one population compared to another population or difference between population subgroups

How to measure health inequality

bullMost measurement of health inequality involves the use of indicators to measure health

Health indicators within the Monitoring Evaluation and Review framework

Source Adapted from Monitoring evaluation and review of national health strategies a country-led platform for information and accountability Geneva World Health Organization 2011

INPUTS AND PROCESSES

OUTPUTS OUTCOMES IMPACT

bull Health financing

bull Health workforce

bull Infrastructure bull Information bull Governance

bull Service access and readiness

bull Service quality and safety

bull Coverage of interventions

bull Risk factors and behaviours

bull Health status bull Financial risk

protection bull Responsiveness

Indicators of Health - classification

bull Mortality indicators

bull Morbidity indicators

bull Disability indicators

bull Nutritional status indicators

bull Health care delivery indicators

bull Health care Utilization indicators

bull Indicators of social and mental health

bull Environmental indicators

bull Socio-economic indicators

bull Health policy indicators

bull Other indicators

Mortality Indicators

a Crude death rate

bull It is defined as the number of deaths per 1000 population

per year in a given community

bull Reducing the number of deaths in the population is an obvious goal of medicine and health care and success or failure to do so is a measure of a nations commitment to better health

Crude death rate = _Number of deaths (all causes)___ 1000

Estimated midyear population


bull Age-specific death rate = ____number of deaths (25-44)_____ 1000

estimated midyear population (25-44)

bull Cause-specific death rate = __Number of deaths (specific cause)__ 100000



b Life expectancy

bull ldquoThe average number of years that will be lived by those born alive into a population if the current age-specific mortality rates persistldquo

bull Life expectancy is a good indicator of socio-economic development in general

bull A minimum life expectancy at birth of 60 years is the goal of Health for All by 2000AD


c Infant Mortality rate bull It is the ratio of deaths under 1 year of age in a given year

to the total number of live births in the same year usually expressed as a rate per 1000 live births

bull It is one of the most universally accepted indicators of health status not only of infants but also of whole population and of the socioeconomic conditions under which they live

bull The global strategy of Health for All has suggested an infant mortality rate of not more than 50 per 1000 live births by 2000 AD


d Child Mortality Rate

bull It is defined as the number of deaths at ages 1-4 years in a given year per 1000 children in that age group at the mid-point of the year concerned

e Maternal Mortality Rate

Maternal Mortality rate

bullMaternal deaths death of a woman 1048633 while pregnant or 1048633 within 42 days of termination of pregnancy 1048633 Irrespective of the duration or site of the pregnancy 1048633 From any cause related to or aggravated by the pregnancy or its management 1048633 Not from accidental causes bullNumber of women who die as a result of complications of pregnancy or childbearing in a given year per 1000 live births in that year bullRepresents both the obstetric risk

Morbidity Indicators

bull Mortality indicators do not reveal the burden of ill health in a community

bull The following morbidity rates are used for assessing ill health in the community

ndash Incidence and Prevalence

ndash Attendance rates at out-patient departments health centers etc

ndash Admission Readmission and Discharge rates

ndash Duration of stay in hospital and


bull Incidence rate = No of new cases of a disease _in a certain time period___ population at risk in same time period No of new and old cases of a disease

bull Prevalence rate = _________in a certain time period________ population at risk in same time period No of new cases in a narrowly defined

bull Attack rate = ______population during a specific time period______ population at risk in same time period

Disability Rates

bull Disability rates related to illness and injury

bull Used to supplement mortality and morbidity indicators

bull Examples

1 number of days of restricted activity

2 work-loss days (or school-loss days)

Nutritional Status Indicators

bull Anthropometric measurements of preschool children ndash eg weight height mid- arm circumference

bull Heights (and sometimes weights) of children at school entry

bull Prevalence of low birth weight (less than 25 kg)

Health Care Delivery Indicators

bull The frequently used indicators of health care delivery ndash Doctor-population ratio ndash Doctor-nurse ratio ndash Population-bed ratio ndash Population per health center ndash Population per traditional birth attendant

bull These indicators reflect the equity of distribution of

health resources in different parts of the country and of the provision of health care

Utilization rates

bull The extent of use of health services

bull Is expressed as the proportion of people in need of a service who actually receive it in given period usually a year

bull Health care utilization is also affected by factors such as availability and accessibility of health services and the attitude of an individual towards his health and the health care system

Utilization rates

bull Examples of utilization rates

bull proportion of infants who are fully immunized against the 6 EPI diseases

bull proportion of pregnant women who receive antenatal care or have their deliveries supervised by a trained birth attendant

bull bed-occupancy rate (ie average daily in-patient censusaverage number of beds)

bull bed turn-over ration (ie dischargesaverage beds)

Socio-economic Indicators bull These indicators do not directly measure health

But they are of great importance in the interpretation of the indicators of health care ndash rate of population increase ndash per capita GNP ndash level of unemployment ndash dependency ratio ndash literacy rates ndash family size ndash housing the number of persons per room ndash per capita calorie availability

Health Policy Indicators

bull Proportion of GNP spent on health services

bull Proportion of GNP spent on health-related activities (including water supply and sanitation housing and nutrition community development)

bull Proportion of total health resources devoted to primary health care

Who compiles health indicators

bullReports are compiled at every local level - Health departments foundations helliphellip

bullNational ndashgovernmentprivate partnerships

bull International ndash WHO

Data Sources for Common Indicators

bull National Vital Statistics System (Birth Mortality)

bull Census data

bull Surveys (Behavioral Risk Factor Survey--Adults and Youth

National Health Interview Survey National Health and

Nutrition Examination Survey National Survey of Childrens

Health National Immunization Survey)

bull Disease Surveillance Systems

bull Health services administrative data


Indicators are like a waterhellip Too little of it you die of thirst Too much you drown in it

By Building Health information system able to

generate a list of Essential indicators covering the basic information needs

Keep it straight forward and simple

Global population health and well-being are both determinants and consequences

of major demographic changes

1 Migration within and across countries

2 Women in the paid workforce

3 Decreases in fertility and increase in life expectancy in many countries

So whatrsquos the world going to look like in the next 20-40 yearshellipby 2025 or 2050

Increasingly urban

Increasingly old

Increasingly diverse with migration

Increasing women in workforce

Global trends in longevity

Global Declines in Fertility

Doomsday scenarios

bull Rising inequality

bull Fragile families and communities

bull New urban areas that canrsquot catch up quickly

bull Environmental consequences

bull Social exclusion and ldquodis- integrationrdquo

bull Increased conflict

Presentation outline 5-6-2017

Time

Indicators and determinants of global health variations

0800 to 0810

Relationship between socio-economic development and disease patterns in different nations

0810 to 0830

What are the social determinants of health

0830 to 0840

What contribution do income education and other factors make to health

0840 to 0900

2






























bull Urbanization

Examples








Health Indicators







indicator as



Health Indicator is













bull Cause of death



















ratio)


indicators








Health inequality






























a Crude death rate












b Life expectancy


























Disability Rates



bull Examples











Utilization rates




Utilization rates


















bull Census data


















Increasingly urban

Increasingly old





Doomsday scenarios




































bull Urbanization

Examples








Health Indicators







indicator as



Health Indicator is













bull Cause of death



















ratio)


indicators








Health inequality






























a Crude death rate












b Life expectancy


























Disability Rates



bull Examples











Utilization rates




Utilization rates


















bull Census data


















Increasingly urban

Increasingly old





Doomsday scenarios







Examples








Health Indicators







indicator as



Health Indicator is













bull Cause of death



















ratio)


indicators








Health inequality






























a Crude death rate












b Life expectancy


























Disability Rates



bull Examples











Utilization rates




Utilization rates


















bull Census data


















Increasingly urban

Increasingly old





Doomsday scenarios







Health Indicators







indicator as



Health Indicator is













bull Cause of death



















ratio)


indicators








Health inequality






























a Crude death rate












b Life expectancy


























Disability Rates



bull Examples











Utilization rates




Utilization rates


















bull Census data


















Increasingly urban

Increasingly old





Doomsday scenarios













indicator as



Health Indicator is













bull Cause of death



















ratio)


indicators








Health inequality






























a Crude death rate












b Life expectancy


























Disability Rates



bull Examples











Utilization rates




Utilization rates


















bull Census data


















Increasingly urban

Increasingly old





Doomsday scenarios







Health Indicator is













bull Cause of death



















ratio)


indicators








Health inequality






























a Crude death rate












b Life expectancy


























Disability Rates



bull Examples











Utilization rates




Utilization rates


















bull Census data


















Increasingly urban

Increasingly old





Doomsday scenarios















bull Cause of death



















ratio)


indicators








Health inequality






























a Crude death rate












b Life expectancy


























Disability Rates



bull Examples











Utilization rates




Utilization rates


















bull Census data


















Increasingly urban

Increasingly old





Doomsday scenarios




















ratio)


indicators








Health inequality






























a Crude death rate












b Life expectancy


























Disability Rates



bull Examples











Utilization rates




Utilization rates


















bull Census data


















Increasingly urban

Increasingly old





Doomsday scenarios













Health inequality






























a Crude death rate












b Life expectancy


























Disability Rates



bull Examples











Utilization rates




Utilization rates


















bull Census data


















Increasingly urban

Increasingly old





Doomsday scenarios



































a Crude death rate












b Life expectancy


























Disability Rates



bull Examples











Utilization rates




Utilization rates


















bull Census data


















Increasingly urban

Increasingly old





Doomsday scenarios













b Life expectancy


























Disability Rates



bull Examples











Utilization rates




Utilization rates


















bull Census data


















Increasingly urban

Increasingly old





Doomsday scenarios





























Disability Rates



bull Examples











Utilization rates




Utilization rates


















bull Census data


















Increasingly urban

Increasingly old





Doomsday scenarios















Utilization rates




Utilization rates


















bull Census data


















Increasingly urban

Increasingly old





Doomsday scenarios







Utilization rates


















bull Census data


















Increasingly urban

Increasingly old





Doomsday scenarios



















bull Census data


















Increasingly urban

Increasingly old





Doomsday scenarios

















Increasingly urban

Increasingly old





Doomsday scenarios









Doomsday scenarios







faculty of medicine public health (31505291)الصحة العامة

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