INDICATORS OF

HEALTH
 What are indicators?
• Indicators are variables to measure changes.
• Indicators are only indication of a given
situation or a reflection of a situation.
• Indicators are used when these changes can
not be measured directly.
 Why indicators are required?
• To measure health status of a community.
• To compare health status of a country with
another.
• For assessment of healthcare needs.
• For monitoring and evaluation of health services,
activities and program.
• Indicators help to measure the extent to which
the objectives and targets of a program are being
attained.
• Indicators are powerful tools for
monitoring and communicating powerful
information about population health.
• Indicators are used to support planning,
identify priorities, develop and target
resources, identify benchmarks and track
progress towards broad community
objectives.
 Characteristics
• Validity (measuring what to be measured)
• Reliability (same outcomes by any individual,
in similar situations)
• Sensitivity (varies to change in situation)
• Specificity (to the situation concerned)
• Feasibility (the ability to give the data needed)
• Relevant (contribute to the topic concerned)
 Health indicators
1. Mortality indicators
2. Morbidity indicators
3. Disability rates
4. Nutritional status indicators
5. Health care delivery indicators
6. Utilization rates
7. Indicators of social and mental health
8. Environmental indicators
9. Socio-economic indicators
10.Health policy indicators
11.Indicators of quality of life
12.Other indicators
 1. Mortality indicators
Crude death rate:-
Number of deaths per 1000 population per year in a given
community.

Expectation of life:-
Life expectancy at birth is the average no. of years that will be
lived by those born alive in to a population if the current age
specific mortality rates persist.

It is a good indicator of socio-economic development.

Decline in crude death rate from 7.4 in 2008 to 7.3 in 2009.

CDR is higher in rural areas i.e. 7.8 as compared to urban areas 5.8
Kerala stands first with life expectancy of 74 years whereas Madhya Pradesh has the
Lowest of 58 years.
Maternal mortality rate ( per 100000 live births)
• Maternal death is the death of a woman while pregnant or within
42 days of termination of pregnancy, irrespective of the duration
and site of the pregnancy, from any cause related to or aggravated
by the pregnancy or its management but not from accidental or
incidental causes.
• It accounts for the greatest proportion of deaths among women of
reproductive age.

Disease specific mortality rate:-

Mortality rates can be computed for specific diseases such as
death by cancer, cardiovascular diseases, accidents, diabetes etc.
Infant mortality rate:-
IMR is the ratio of deaths under 1 year of age in a
given year to the total no. of live births in the same
year usually expressed as a rate per 1000 live births.

Child mortality rate:-

No. 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.
It thus excludes infant mortality.
 2.Morbidity indicators
• Mortality indicators alone do not reveal the burden of ill health in
a community, so to supplement mortality indicators and to
describe heath status of a population, morbidity indicators are
used.
The following morbidity rates are used for assessing ill health in the
community:-
I. Incidence and prevalence
II. Notification rates
III. Attendance rates at OPD, health centers etc.
IV. Admission , readmission, discharge rates
V. Duration of stay in hospital
VI. Spells of sickness or absence from work or school
 3. Disability rates

Disability rates

Person type
Event type indicators indicators

1. No. of days of restricted activity

2. Bed disability days 1. Limitation of mobility
3. Work loss days within a specific 2. Limitation of activity
period
• Sullivan’s index :-
This index ( expectation of life free of disability) is computed
by subtracting from the life expectancy the probable duration
of bed disability and inability to perform major activities.
• HALE (Health-adjusted life expectancy ):-
HALE is based on life expectancy at birth but includes an
adjustment for time spent in poor health. Or the
equivalent no. of years in full health that a new born can
expect to live based on current rates of ill health and
mortality.
DALY:-
• Disability adjusted life years is a measure of
burden of disease in a defined population
and the effectiveness of the interventions.
• DALY express years of life lost to pre mature
death.
• One DALY is one lost year of healthy life.
 4. Nutritional status
• It is a positive indicator.
• 3 nutritional status indicators are considered
important as indicators of health status-
a. anthropometric measurement of pre
school children.
b. height and weight of children at school
entry.
c. prevalence of low birth weight.
5. Health care delivery indicators

• Doctor population ratio

• Doctor nurse ratio
• Population bed ratio
• Population per health/sub centre
• Population per traditional birth attendant.

These indicators reflect the equity of distribution

of health resources in different parts of country.
 6. Utilization rates
• Utilization of services or 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.
• Few example of utilization rates:
 proportion of infants who are fully immunized.
 proportion of pregnant women who receive
antenatal care.
 bed occupancy rate. etc…
7. Indicators of social and mental health

• Suicide
• Homicide
• Other acts of violence or crime
• Road traffic accidents
• Alcohol and drug abuse
• Smoking
• Obesity
 8. Environmental indicators
• It reflect the quality of physical and biological
environment in which disease occur and in
which the people live.
• These include indicators relating to:
air, water, radiation, noise, solid wastes etc..
 9.Socio economic indicators.
• Rate of population increase
• Per capita GNP
• Level of unemployment
• Literacy rates
• Family size
• Per capita calorie intake
• Housing (no. of persons
per room)
 10. Health policy indicators
• Most important political commitment
indicator is “allocation of adequate resources”.
• Other indicators are proportion of GNP spent
on health services.
• Proportion of total health resources devoted
to primary health care.
 11. Indicators of quality of life
• Physical quality of life index - The Physical Quality of
Life Index (PQLI) is an attempt to measure
the quality of life or well-being of a country. The
value is the average of three statistics: basic literacy
rate, infant mortality, and life expectancy at age one,
all equally weighted on a 0 to 100 scale.
• Human development index
• Gender related development index and gender
empowerment measure (designed to measure of
gender equality).
 12. Other indicators
• Social indicators
• Basic need indicators
• Health for all indicators