HSH211 Lecture Notes - Lecture 3: Economic Evaluation, Maternal Death, Age Adjustment

54 views4 pages

27 May 2018

School

Department

Course

Professor

For unlimited access to Class Notes, a Class+ subscription is required.

Health status and vital statistics

The health system has responsibility for the measurement of health status. Health systems use the

concept of vital statistics to measure health outcomes, and these are also proxies for health system

performance.

Vital statistics

Life expectancy

Definition- The average length of life for people in a community or population. It measures how

long, on average a person is expected to life based on current age and sex-specific death rates or in

other words the number of years of life a person born today is expected to live if current mortality

rates continue.

• Life expectancy is the most commonly used health measure to describe population health and

reflects the overall mortality level of population

• Life expectancy estimates cannot take into account future changes in mortality and therefore

are used as a summary measure, not for an accurate prediction.

• Life expectancy is usually calculated as an average across a number of years to improve

accuracy and reduce variability

Australia's life expectancy

• Males 80.3 years, females 84.4 years (204)

• Ranking 6th for males and 9th for females in the world

• Average life expectancy has increased substantially between the 20th and 21st century. Boys

and girls were expected to live around 33 an 34 years longer than their counterparts born at

the start of the period.

Mortality

• The mortality rate of a population is the measure of the number of deaths in a defined

population over a defined period. It is calculated by counting the deaths in that population

during the period and dividing the number by the number of people in that population.

• Because the number of people in a population can change over time, the mortality rate is

usually calculated by dividing the number of deaths by the size of the population in the middle

of the period. The rate is usually multiplied by 100,000. If the number of deaths is large, then

the rate can be reported multiplied by 1000.

All causes of mortality

All deaths in the population are counted

Cause-specific mortality

Only deaths from a specific cause are counted

Age-standardised mortality rates

The rates calculated above (All causes of mortality and cause-specific mortality) are referred to as

crude mortality rates as they do not take into account the ages of people in the population or the

number of men and women in the population.

The risk of death varies by age and is different for men and women at any given age, so we usually

present mortality rates which are adjusted for these differences.

find more resources at oneclass.com

Unlock document

This preview shows page 1 of the document.
Unlock all 4 pages and 3 million more documents.

Already have an account? Log in

Document Summary

The health system has responsibility for the measurement of health status. Health systems use the concept of vital statistics to measure health outcomes, and these are also proxies for health system performance. Definition- the average length of life for people in a community or population. Life expectancy is the most commonly used health measure to describe population health and reflects the overall mortality level of population. Life expectancy estimates cannot take into account future changes in mortality and therefore are used as a summary measure, not for an accurate prediction. Life expectancy is usually calculated as an average across a number of years to improve accuracy and reduce variability. Australia"s life expectancy: males 80. 3 years, females 84. 4 years (204, ranking 6th for males and 9th for females in the world, average life expectancy has increased substantially between the 20th and 21st century.

Related Questions

QUESTION 1 1. The relative importance or burden of a disease within a population will depend on a number of factors including : A. Disease frequency B. Disease severity C. Disease consequences D. All of the above

QUESTION 2 1 . With the epidemiologic transition, there is a reduction in malnutrition and _____ . A. Communicable diseases B. Injuries C. Non-communicable chronic diseases D. Mental health disorders

QUESTION 3 1. A major challenge to developing a burden of disease profile in low and middle-income countries relates to A. Unwillingness to share complete information B. Conflicting disease definitions C. Challenges obtaining information related to cause of death D. All of the above

QUESTION 4 1. The demographic transition describes which of the following changes to society A. Changes in birth and death rates that reflect a modern society B. Declines in mortality followed by a reduction in fertility C. A change in the age structure of the population D. All of the above

QUESTION 5 1. Measures of health status that combine mortality and morbidity data A. Facilitate comparisons both within and across populations B. Help estimate the quantitative health benefits from interventions C. Serve as tools to assist with resource allocation D. All of the above

QUESTION 6 1. The disability-adjusted life year is defined as A. A health gap population summary measure that combines time lost due to disability with that lost due to death B. A measure to compare the gap between the current situation to that of an ideal situation C. A measure that combines the amount of healthy life lost due to morbidity with that lost due to injury. D. Answers B and C

QUESTION 7 1. True or false? A key limitation to mortality-based indicators is that they fail to account for the morbidity caused by disease. True False

QUESTION 8 1. The most widely used composite measure of population health is the DALY, and this epidemiological measure is the sum of morbidity and ________data. A. Years of life lost (YLL) B. Morbidity C. Infant mortality rates (IMR) D. none of the above

QUESTION 9 1. What would be the best source of information on adult and infant mortality (in high income countries)? A. Disease registers B. Vital statistics C. Special survey study D. Hospital clinic statistics

QUESTION 10 1. Which term is best used to describe the proportion of people in a population who have a defined disease at a specific point of time? A. DALY B. Incidence C. Mortality rate D. Prevalence

QUESTION 11 1. Which term is best used to describe new cases of disease occurring in a population? A. DALY B. Incidence C. Mortality rate D. Prevalence

QUESTION 12 1. Which term is used to describe the absence or presence of illness or disease? A. Demography B. Morbidity C. Mortality D. Vitality

QUESTION 13 1. Mortality (death indicators) include: A. Mortality rate B. Infant mortality rate C. Neonatal morality rate D. All of the above

QUESTION 14 1. True or false? The value of life is often implicit in the way resource allocation decisions are made, which suggests that these decisions should be as explicit, open, and transparent as possible. True False

QUESTION 15 1. _________________is projected as the number one leading cause of disease burden in 2030. A. Ischemic heart disease B. Diabetes mellitus C. HIV/AIDS D. Unipolar depression

QUESTION 16 1. Some of the negative aspects of globalization include A. Greater insecurity of employment B. Poorer housing and sanitation due to rapid urbanization C. Greater vulnerability to environmental degradation D. All of the above

QUESTION 17 1. Current concerns about climate change focus on several developments including A. Rising global average land and sea surface temperature B. Increasing frequency of extreme weather conditions C. Both A and B D. None of the above

QUESTION 18 1. True or false? Diseases carried by mosquitoes are especially sensitive to meteorological conditions because they are vulnerable to changes in the ambient temperature. As a result of changing temperatures, infectious diseases such as malaria and dengue have decreased in incidence and geographic range. True False

QUESTION 19 1. True or false? International cooperation of infectious disease control has a long history that includes obligatory reporting of outbreaks of specific diseases. However, compliance with obligatory reporting has been poor due to economic consequences that have often accompanied notification of disease outbreaks. True False

QUESTION 20 1. True or false? Globalization is a relatively new phenomenon that began in the mid-20th century. True False

1. The economic analysis method used when there are alternative ways of attaining a single type of outcome is:

	Cost-effectiveness analysis
	Cost-minimization analysis

	Cost-utility analysis
	Cost-consequence analysis

2. If a new treatment is less costly than an old treatment and the new treatment is more effective then:

	Neither treatment is dominant.
	The old treatment is dominant.

The new treatment is dominant.

3. An example of a holistic measure is:

	Childhood immunization status.
	Tobacco use assessment.

	Adult weight screening.
	Survival time.

4. An example of an economic cost is:

	Taxes.
	Unemployment insurance payments.

	Lost productivity.
	Social security payments.

5. When the outcomes are the same for all of the interventions being studied, then the economic analysis method that can be applied is:

	Cost-minimization analysis.
	Cost-effectiveness analysis.

	Cost-utility analysis
	Cost-consequence analysis

6. A health economist was asked to compare the outcomes and cost of two diabetic therapies that affected both the severity of the disease and the survival rate. What evaluation concept should he/she use?

	Concept of cost-effectiveness
	Concept of cost-utility

	Concept of cost-minimization analysis
	Concept of benefit-Cost

7. A health economist was asked to compare outcomes and costs for two prophylactic medicines that reduced deaths during surgical operations. The interventions did not influence quality of life. What concept should he/she use?

	Concept of cost-effectiveness
	Concept of cost-utility

	Concept of cost-consequence analysis
	Concept of benefit-Cost

8. A health economist was asked whether a new drug that reduced mortality should be used. What concept should he/she use?

	Concept of cost-effectiveness
	Concept of cost-minimization analysis

	Concept of benefit-cost
	Concept of cost-utility

9. To determine which treatment is dominating, what economic analysis method is used?

	Increment cost-effectiveness ratio
	Benefit-cost analysis.

	Cost-minimization analysis
	Cost-consequence analysis

Cost-utility analysis

10. In a population of 1,000 persons at the beginning of the year, 40 die during the year. How many life years were there during the year?

	920 life years
	980 life years

	960 life years
	990 life years

bronzecat728

Case Study

Skolnikland is in Eastern Africa, with a population of 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country includes both hills and mountains. There are two seasons of heavy rainfall.

The citizens come from several ethnic groups that tend to live in their own regions and speak different languages. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The people from this group live in the capital and most of the large cities. The national language is the language of this dominant ethnic group.

According to World Bank criteria, Skolnikland is among the poorest countries in the world. The economy has been growing at about 4% per year on average over the last decade, but the economy had very slow economic growth in the decades prior to that. The richest 10% of the population controls 80% of the national income.

About 80% of the people live in rural areas and 20% in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. Most people earn their livelihood in agriculture but there is an increasing garment manufacturing industry in the two largest cities. There are also a number of mining industries. In addition, other export industries are beginning to grow, mostly focused on the export of commodities to China.

The total fertility rate is about 4.5 but it has been declining slowly over the last two decades, from over 6. There is an almost equal number of men and women in the population. Infant mortality is about 90 per 1,000 live births. Maternal mortality is about 500 per 100,000 live births. Thirty-five percent of the children are underweight for age.

The adult literacy rate is about 40%. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing slowly, but steadily. Most recently, this rate has been growing at an increasing pace and about 75% of the girls now attend school regularly, although many of them are of very low quality.

Only about 50% of citizens have access to safe water. Only about 30% have access to sanitary disposal of human waste.

HIV prevalence is 7% of the adult population. The number of new HIV cases annually has begun to plateau. About half of the people eligible for treatment for HIV are on treatment. Malaria is rampant in the plains.

Investments in the road system have been growing at a solid pace in the last decade and the use of private automobiles has begun recently to increase more rapidly.

Skolnikland has a pluralistic health system that is made up of public and private institutions, publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, which the better off people do not attend. The health system is not very effective or efficient and is generally of low quality. The HIV, TB, and malaria programs are not effective or efficient and they are just beginning to adopt paradigms for services that follow global best practices.

QUESTION 26

What is a DALY?