Indicators of Health

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 :

  1. Measurements and proportions of pre-school children.
  2. Heights and sometimes weights of school level children
  3. 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 Indicators

This 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:

  1. Doctor-population ratio
  2. Doctor-nurse ratio
  3. Population-bed ratio
  4. Population per health/subcentre
  5. Population per traditional birth attendant

F. Utilization Rates

These measures are used to measure the usage of the health services and is measured under the following categories:

  1. Proportion of infants who have received complete immunization programme.
  2. Proportion of pregnant women who have received complete ante-natal care
  3. Percentage of population using or adapted to various procedures under family planning
  4. Hospital bed occupancy rate
  5. 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:

  1. Pollution
  2. Radiation
  3. Solid wastes
  4. Access to safe water etc.

Socio-economic indicators do not directly measure Health but help in interpretation of the indicators of health 

H. Health Policy Indicators

This makes them the most important information rearrangement of sympoms in a present society.

I. Other Indicators may include :

  1. Indicators for quality of Life
  2. Basic needs indicators
  3. Health for All Indicators

How is Your Health Account? Are You Among the Super-Healthy, the Walking-ill or the Lying Down Ill?

Check your health balance by reading the following descriptions.

The features of super-health are:

  • Boundless energy – of course you get tired but it is a natural tiredness. You have the energy to do the things that you want to do, you work hard at those things and feel tired at the end of the day.
  • Perspective on life – you feel satisfied with your life and the way that you are living it. What you do with your time has purpose and meaning for you. You don’t necessarily live in a perpetual ‘bed of roses’, you have trial the same as everyone else, but these trials don’t overwhelm you.
  • Sharp mind – you are able to concentrate well, have a good memory, are able to understand and think well and you can learn new things.
  • Positive outlook – you are optimistic about the future. You believe that you will be able to achieve the things that you want.
  • Full of the joy of life – life is a pleasure for you, you enjoy the thing that you have to do and you have plenty of ‘fun’ in you life.
  • Physically fit with a toned body – you eat well and have an aerobic, flexibility and strength exercise program that you work with as a part of your daily routine.
  • Rarely or never ill – you don’t suffer from ill health and very rarely have colds or any other problems.
  • Leading a full life – you have many commitments in your life but you have balance and time for yourself. Your energy and fitness mean that you feel in control and happy with what you are doing.
  • Contented – you are happy with your life in all its areas and feel in control enough that you could work on changing things if this became necessary.

The features of the walking-ill are:

  • Constant tiredness – you frequently feel drained and lacking in energy. Even if you don’t have to do a great deal on any particular day you still feel tired.
  • Low concentration – you have difficulty focusing and completing tasks, your memory is not what it used to be and you sometimes find it difficult to understand and learn new things.
  • Mood swings – you sometimes feel good but often you are depressed and anxious.
  • Exhausted by exercise – you don’t feel you have the energy to start let alone stick to an exercise program and if you do try you are left feeling exhausted. As a consequence you are unfit
  • Run down, frequently ill – you frequently have headaches, colds or flu, constipation or diarrhea, hay fever etc. You frequently need to take time of work.
  • Easily overwhelmed – you get stressed easily and don’t feel in control of what is happening in your life. You frequently feel that there isn’t enough time for you to do things.
  • Flabby – because have little chance to exercise and are unfit you are not as toned as you would like to be and you find that you put on weight very easily.
  • Dissatisfied – you life is not heading in the direction that you would like and you are not satisfied with yourself and many aspects of your life.

The features of the lying down ill are:

  • Chronic fatigue and exhausted – you are barely able to find the energy to do the basics in life. You feel drained and even if you are able to rest all day you don’t feel any better.
  • Constant aches and pains – your joints and muscles ache and you often have other pains as well. These pains could be migraines, menstrual cramps or back aches, etc.
  • Chronic depression – you feel down most of the time and are pessimistic about your future. You do not feel that you have much control over what is happening to you.
  • Unable to exercise – you do not have the energy and you have too much pain or are too ill to be able to exercise.
  • Incapacitated by illness – you have at least one major illness which prevents you from doing many of the things that you would like to do.
  • ‘life is hard work’, ‘life is against me’ – you find things in life difficult to cope with and that there is little that you can control.
  • Despairing – you feel there is little left in life for you.

Where are you? Are you in super-health? Are you among the walking-ill or the lying down ill? A great number of people fall into the walking-ill category – lacking in enthusiasm and energy for life. Many also come into the lying down ill – chronically exhausted, depressed and incapacitated by ill health.

If you are in the walking-ill category how would it be to sit comfortably and consistently in the super-health category – full of both energy in the body and mind?

If you are in the lying down ill category how would it be to feel more energy and enthusiasm and live longer and healthier and as free from disease as possible?

You can do these things if you have the ‘know how’ and the willingness to work on improving your health. If you are in the walking-ill or the lying down ill categories then you need to make improving your health a priority – so that you can live your life to its fullest.

Health Supplements-Growing Demand and Credibility

A growing number of consumers are turning to health supplements as an alternative or addition to mainstream medicine. Today’s consumers are savvy and understand the benefits of the ingredients found in health supplements for good health and well-being. While they are apprehensive of nutritional products, they value brands that offer manufacturing credibility and prefer products formulated under doctor supervision.

As more consumers place priority on their health, health supplements are fast becoming a popular choice.This focus is reflected in the booming growth of the U.S. dietary supplement market, presently estimated to be valued at $24-25 billion. In spite of prevailing doubts about the integrity of health supplement manufacturers, the rising cost of raw materials and new regulations, the health supplement industry is projected to rise by 4-6% in the next year. By the year 2010 growth in the global nutraceuticals industry is projected to reach $187 billion.

According to NMI’s 2007 Health & Wellness Trends Survey, the top health categories for supplements are weight loss, cardiovascular support, digestion, arthritis or joint pain relief, seasonal allergy relief, vision and eye health, and diabetes.”Customers believe in the industry. A recent study found that 34% of consumers looking to lose weight first turn to a dietary supplement as their adjunct in the battle against obesity,” says Douglas S. Kalman, director of nutrition and applied clinical research at Miami Research Associates and chair of the Nutrition in Complementary Care Dietetic Practice Group (NCC-DPG).

According to an annual survey conducted by Ipsos-Public Affairs for the Council for Responsible Nutrition (CRN), Washington, D.C. “Consumers’ use of dietary supplements remained fairly consistent in 2007, with 68% of American adults saying that they take dietary supplements.”Consider these statistics by the Office of Dietary Supplements:

* 31.8% of American children use dietary supplements (18 and younger).

* 47% of American men use dietary supplements.

* 57% of American women use dietary supplements.

The most commonly used dietary supplements are multivitamins and minerals (18.3%). A recent study conducted by the NCAAM, shows a list of why people use dietary supplements, the most common reasons are general health, arthritis, memory improvement, to prevent osteoporosis, for energy, recommended by physician, friend, family or through media, for immune health, to prevent colds/influenza, and as sleep aids.Health supplements most commonly purchased are:

* 40% vitamins

* 29% herbals & botanicals (ginkgo, echinacea, St. John’s Wort, ginseng, garlic)

* 10% sports nutrition

* 8% minerals

* 8% specialty supplements (melatonin, fish oil, amino acids, etc.)

(www.snac.ucla.edu)

The top supplements used by consumers in 2007, in order of frequency are multivitamins, calcium, vitamin C, fish oil, vitamin E, antioxidants, vitamin B/B complex and omega 3s. (NMI survey).Why are Health Supplements Gaining Credibility?

There are more than 20,000 products on the market. Many consumers believe that health supplements can support their bodies to fight disease or improve health. Exactly why are health supplements gaining credibility?One of the reasons is the advances in science and technology. Most credible health supplement manufacturers use strict manufacturing policies combined with a professional team of researchers who develop products based on evidence based scientific research.

Through clinical studies and systematic reviews scientist evaluate the health benefits and safety risks of health supplements. This has built consumer confidence.An example of this is omega-3 fatty acid supplementation. There is strong evidence from epidemiologic and clinical trials indicating the consumption of omega-3 fatty acid as being beneficial to people who are at risk of coronary heart disease. The American Heart Association validates this: “Omega-3 fatty acids benefit the heart of healthy people, and those at high risk of – or who have – cardiovascular disease”Consumer interest in health supplements is now reinforced by doctors and healthcare professionals.

A report from CRN’s Healthcare Professionals Impact Study states that “more than three-quarters of U.S. physicians (79%) and nurses (82%) recommend dietary supplements to their patients.” As dietary supplements receive more support from clinical trials, there will be a rise in the number of recommendations of health supplements by healthcare professionals to their patients.

Another factor which will boost future sales is the recent finalization of U.S. Good Manufacturing Practices (GMPs) rules and requirements for the manufacture of dietary supplements and the new Adverse Event Reporting (AER) law. “The burden of compliance is really key for consumer confidence,” says Daniel Fabricant, vice president of scientific affairs, Natural Products Association (NPA), Washington, D.C. Health supplements are the future in preventive medicine. With DNA diagnostics becoming more common, and the role of nutrition against disease gaining surer footing, the health supplement industry is poised to meet the challenges of the future health industry.

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