Indicators of health in chn
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Indicators of Health in Community Health Nursing (CHN)
Source: Park's Textbook of Preventive and Social Medicine
What Are Health Indicators?
Indicators are variables that help measure changes in health status. They are needed to:
- Measure the health status of a community
- Compare health between countries/regions
- Assess health care needs
- Allocate scarce resources
- Monitor and evaluate health services and programmes
A health index is an amalgamation of several health indicators combined into one composite measure.
Characteristics of an Ideal Indicator
An ideal health indicator should be:
| Criterion | Meaning |
|---|---|
| Valid | Measures what it is supposed to measure |
| Reliable & Objective | Gives the same result if measured by different people |
| Sensitive | Sensitive to changes in the situation |
| Specific | Reflects changes only in the situation concerned |
| Feasible | Data can actually be collected |
| Relevant | Contributes to understanding the phenomenon of interest |
Classification of Health Indicators
Since health is multidimensional, it must be understood through a profile of many indicators:
1. Mortality Indicators
These are the most traditional and widely used indirect measures of health status.
| Indicator | Description |
|---|---|
| (a) Crude Death Rate | Deaths per 1,000 population per year; a fair but imperfect comparator |
| (b) Life Expectancy at Birth | Average years expected to live; a global health indicator; a positive indicator |
| (c) Age-Specific Death Rate | Death rate within specific age groups |
| (d) Infant Mortality Rate (IMR) | Deaths under 1 year per 1,000 live births; most universally accepted health indicator; sensitive to quality of perinatal care |
| (e) Child Death Rate | Deaths in 1-4 year age group per 1,000 children; reflects MCH services, nutrition, immunization |
| (f) Under-5 Proportionate Mortality Rate | Proportion of all deaths occurring in under-5 age group |
| (g) Adult Mortality Rate | Probability of dying between ages 15-60 per 1,000 population |
| (h) Maternal Mortality Rate | Greatest proportion of deaths in reproductive-age women; reflects socio-economic status |
| (i) Disease-Specific Mortality Rate | Rates for specific causes - cancer, CVD, accidents, diabetes |
| (j) Proportional Mortality Rate | Proportion of all deaths from a specific cause; communicable disease PMR indicates preventable mortality |
| (k) Case Fatality Rate | Deaths from a disease / cases of disease × 100; measures disease severity/pathogenicity |
| (l) Years of Potential Life Lost (YPLL) | Life years lost through premature death before age 75 |
2. Morbidity Indicators
Used to supplement mortality data since mortality alone doesn't reveal the full burden of ill-health (e.g., mental illness, rheumatoid arthritis).
- Incidence and prevalence rates
- Notification rates (for notifiable diseases)
- Attendance rates at OPD, health centres
- Admission, readmission, and discharge rates
- Duration of stay in hospital
- Spells of sickness or absence from work/school
3. Disability Rates
Used when death rates no longer change markedly despite health expenditures. Based on the premise that health implies a full range of daily activities.
(a) Event-type indicators:
- Number of days of restricted activity
- Bed disability days
- Work-loss or school-loss days
(b) Person-type indicators:
- Limitation of mobility (confined to bed/house, needing special aid)
- Limitation of activity in basic ADLs (eating, washing, dressing, toileting)
Composite disability-adjusted measures:
| Measure | Description |
|---|---|
| HALE (Health-Adjusted Life Expectancy) | Life expectancy adjusted for time spent in poor health |
| QALY (Quality-Adjusted Life Year) | Years of life + quality; 1 = perfect health, 0 = death; used in health economics |
| DFLE (Disability-Free Life Expectancy) | Average years expected to live free of disability |
| DALY (Disability-Adjusted Life Year) | = YLL + YLD; overall disease burden; 1 DALY = 1 year of healthy life lost |
4. Nutritional Status Indicators
Nutritional status is a positive health indicator. Three key measures:
- Anthropometric measurements of preschool children (weight, height, mid-arm circumference)
- Heights/weights of children at school entry
- Prevalence of low birth weight (< 2.5 kg)
5. Health Care Delivery Indicators
Reflect equity of distribution and provision of care:
- Doctor-population ratio
- Doctor-nurse ratio
- Population-bed ratio
- Population per health/sub-centre
- Population per trained birth attendant
6. Utilization Rates
Reflect how much of a health service is actually being used:
- Proportion of infants fully immunized against 9 EPI diseases
- Proportion of pregnant women receiving antenatal care
- Percentage using family planning methods
- Bed-occupancy rate
- Average length of hospital stay
- Bed turnover ratio
7. Indicators of Social and Mental Health
Valid positive indicators are scarce; indirect measures (social pathology) are used:
- Suicide and homicide rates
- Road traffic accidents
- Juvenile delinquency
- Alcohol and drug abuse
- Smoking rates
- Obesity
- Family violence, battered-baby and battered-wife syndromes
8. Environmental Indicators
Reflect the quality of physical/biological environment:
- Air and water pollution measures
- Radiation and noise levels
- Proportion of population with access to safe water (within 15 min walking distance)
- Proportion with adequate sanitation facilities
9. Socio-Economic Indicators
Do not directly measure health but help interpret health indicators:
- Rate of population increase
- Per capita GNP
- Level of unemployment
- Dependency ratio
- Literacy rates (especially female literacy)
- Family size
- Housing (persons per room)
- Per capita calorie availability
10. Health Policy Indicators
Reflect political commitment to health:
- Proportion of GNP spent on health services
- Proportion of GNP spent on health-related activities (water, sanitation, housing, nutrition)
- Proportion of health resources devoted to primary health care
11. Indicators of Quality of Life
Attention has shifted from mere survival to quality of living. The Physical Quality of Life Index (PQLI) consolidates three indicators:
- Infant mortality
- Life expectancy at age one
- Literacy
12. Social Indicators (UN Classification)
12 categories defined by the UN Statistical Office including: population, family formation, education, employment, income distribution, health services, housing, public order, time use, leisure, and social stratification.
13. Basic Needs Indicators (ILO)
- Calorie consumption
- Access to water
- Life expectancy
- Deaths due to disease
- Illiteracy
- Doctors and nurses per population
- Rooms per person
- GNP per capita
Special Indicator Series
"Health for All" Indicators (WHO)
Four categories for monitoring HFA progress:
- Health policy indicators - political commitment, resource allocation, equity, community involvement
- Social and economic indicators - population rate, GNP, income distribution, literacy, housing, food
- Indicators for health care provision - availability, accessibility, utilization, quality of care
- Health status indicators - low birth weight %, IMR, child mortality rate, life expectancy, maternal mortality, morbidity, disability
Millennium Development Goal (MDG) Indicators
Key health-related MDG indicators included:
- Under-5 mortality rate, IMR, measles immunization coverage (Goal 4 - child mortality)
- Maternal mortality ratio, skilled birth attendance (Goal 5 - maternal health)
- HIV/AIDS, malaria, and other disease prevalence measures (Goal 6)
- Park's Textbook of Preventive and Social Medicine, pp. 29-33
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