INDICATORS OF

HEALTH

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Plan Of Presentation
Introduction
Health
Indicators of Health
Characteristics
Uses
Classification of Indicators of Health
Millennium Development Goals
Summary
References

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Health
Health is defined as “a state of complete physical, mental
& social wellbeing, and not merely an absence of disease
or infirmity” (WHO)
This statement has been amplified to include the
ability to lead a “socially and economically productive
life”
Health cannot be measured in exact measurable forms
Hence measurement have been framed in terms of illness
(or lack of health), consequences of ill-health (morbidity,
mortality) & economic, occupation & domestic factors
that promote ill health- all the antithesis of health.

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Indicators of Health
Indicator also termed as Index or Variable is only an
indication of a given situation or a reflection of that
situation
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.
Health Index is a numerical indication of the health of a
given population derived from a specified composite
formula.
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 Characteristics
• Valid
• Reliable
• Sensitive
• Specific
• Feasible
• Relevant

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Uses of Indicators of Health
Measurement of the health of the
community.
Description of the health of the
community.
Comparison of the health of different
communities.
Identification of health needs and
prioritizing them.

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 Concurrent evaluation and terminal
evaluation of health services.
Planning and allocation of health
resources.
Measurement of health successes.

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Indicators of Health

Mortality Indicators Morbidity

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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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 Mortality Indicators
1.Crude Death Rate
fair indicator of the comparative health of the
people.
It is defined as the number of deaths per 1000
population per year in a given community, usually
the mid-year population
The usefulness is restricted because it is
influenced by the age-sex composition of the

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 population, socioeconomic and socio-cultural
environment of the communities.
Current CDR is 7.48 deaths/1,000 population
Mortality Indicators
2.Expectation of life
the average number of years that will be lived by
those born alive into a population if the current
age specific mortality rates persist.
It is a statistical abstraction based on existing
agespecific death rates.

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 Estimated for both sexes separately.
Good indicator of socioeconomic development
Positive health indicator of long time survival
Life expectancy at birth:
Total population: 66.8 years
Male: 65.77 years female: 67.95 years
3.Infant mortality rate
The ratio of deaths under 1yr 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

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Indicator of health status of not only infants
but also whole population & socioeconomic
conditions
Sensitive indicator of availability, utilization
&effectiveness of health care, particularly
perinatal care.
Current IMR – 47.57/1000live birth
Child Mortality Rate
The number of deaths at ages 1-4yrs in a
given year, per 1000 children in that age
group at the mid-point of the year.

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Correlates with inadequate MCH services,
malnutrition, low immunization coverage
and environmental factors
Current rate – 18/1000
Other indicators are Perinatal mortality rate,
Neonatal mortality rate, Stillbirth rate, etc.
Correlates with inadequate antenatal care
and perinatal care

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 Mortality Indicators

Maternal Mortality Rate

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 Morbidity Indicators
Morbidity Indicators:The frequency with which a disease
appears in a population.
reveal the burden of ill health in a community, but do not
measure the subclinical or in apparent disease states.
1. Incidence and Prevalence
Incidence
The number of new events or new cases of a disease in a
defined population, within a specified period of time.
E.g. Incidence of TB (new sputum+ve cases) is 168 per
100000 population per year
Prevalence

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 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
Reflects the chronicity of the disease
E.g. Prevalence of TB (sputum+ve in population) is
249 per 100000 population
Morbidity Indicators
2. Notification rates is calculated from the reporting to
public authorities of certain diseases e.g. yellow fever ,
poliomyelitis
- They provide information regarding geographic clustering
of infections, quality of reporting system etc.

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3. Attendance rates at OPDs and at health centers.
4. Admission, Readmission and discharge rates.
5. Duration of stay in hospital – reflects the virulence and
resistance developed by the etiological factor
6. Spells of sickness or absence from work or school.
- reflects economical loss to the community
7. Hospital data constitute a basic and primary source of
information about diseases prevalent in the
community.
Disability Rates
Disability Rates are of two categories
Event type Indicators
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- number of days of restricted activity
- bed disability days
- work-loss days within a specified period
Person type Indicators
- limitation of mobility e.g. confined to bed, confined to house,
special aid in getting around.
- limitation of activity e.g. limitation to perform the basic
activities of daily living (ADL) e.g. eating, washing, dressing,
etc.
Nutritional Status Indicators
Nutritional Status is a positive health
indicator. Newborns are measured for their

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 i. Birth–weight ii. Length etc.
They reflect the maternal nutrition status.
Anthropometric measurements of pre-school
children. i. Weight – measures acute malnutrition.
ii. Height – measures chronic malnutrition.
Growth Monitoring of children is done by measuring
weightfor-age, height-for-age, weight-for- height, head &
chest circumference and mid-arm circumference.
In adults Underweight, Obesity and Anemia are generally
considered reliable nutritional indicators.

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 Health Care Delivery Indicators
These indicators reflect the equity of
distribution of health resources in different
parts of the country and of the provision of
health care
Doctor-population Ratio – 1/1700 (sug. norm
1/3500)
Nurse-population ratio – 0.8/1000 (sug. norm
1/500)
Population-bed Ratio – 8.9/10000
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 Utilization Rates
Utilisation Rates or actual rates is expressed as the proportion
of people in need of a service who actually receive it in a
given period, usually a year
• It depends on availability & accessibility of health services
and the attitude of an individual towards health care system
• They direct attention towards discharge of social
responsibility for the organization in delivery of services
• E.g.
1. Proportion of infants who are fully immunized – 43%
2. Proportion of pregnant women who receive ANC care or
have institutional deliveries
3. Percentage of population who adopt family planning
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4. Bed occupancy ratio, bed-turn over ratio, etc.
Indicators of Social and Mental
Health
These Include rates of suicide, homicide, other
crime, road traffic accident, juvenile delinquency,
alcohol and substance abuse, domestic violence,
battered-baby syndrome, etc.
These indicators provide a guide to social action for
improving the health of people.
Social and mental health of the children depend on their
parents.
E.g. Substance abuse in orphan children

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Environmental Indicators
These reflect the quality of physical and biological
environment in which diseases occur and people live.
The most important are those measuring the
proportion of population having access to safe
drinking water and sanitation facilities.
These indicators explains the prevalence of
communicable diseases in a community
The other indicators are those measuring the
pollution of air and water, radiation, noise pollution,
exposure to toxic substances in food and water

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 Socioeconomic Indicators
These do not directly measure health but are important in
interpreting health indicators.
These are,
• Rate of growth of population: India-decadal(2001-2011)-
17.64%,annual(2011)-1.344% Karnataka -17.51% (2001-2011)
• Family size India-4.8 Karnataka - 4.6
• Housing – the number of persons per room
• Per capita “calorie” available
Countries with favourable socioeconomic indicators have
reported less health related problems.

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 Health Policy Indicators
The single most important indicator of political
commitment is allocation of adequate resources
The relevant indicators are
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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Indicators of Quality of Life
Life expectancy is no longer important
The Quality Of Life has gained its importance
Physical Quality of Life Index
It consolidates infant mortality, life expectancy at
age of 1yr and literacy.
For each component the performance of individual
country is placed on a scale of 1 to 100.

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The composite index is calculated by averaging the
three indicators giving equal weight to each of
them.
The resulting is placed on the 0 to 100 scale.
Indicators of Quality of Life

Human Development Index

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i. longevity( life expectancy at birth) ii.
knowledge (2/3 adult literacy rate and
1/3 mean years of schooling)
iii.income (real GDP per capita in
purchasing power parity in US dollars).

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 Question asked???

What are Health indicators?

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