January 20, 2014
Dr. Deonandan Guest Lecture: Health Indicators
• What is an indicator?
o A statistical value that provides an indication of the condition
o They’re used to monitor the extent to which certain diseases are affecting the
population (ie. Risk factors, targeted population, etc.)
o To monitor the extent to which programs are succeeding.
o To best inform decision making.
o Continuous strides to make better indicators.h
• Situation: “Old Fart Disease” has a 100% fatality to those 65+ and 1% fatality to those
under 65; accounting, in total, for 10% of all fatalities.
o Retirement age; no longer part of the work force.
o Case Fatality Rate: if you get this disease, what are the chances you’re going to
Vs. PMR: how many people dying per disease?
o Value-laden decision to be made; what is desired outcome?
• Pragmatic Aspects of Indicator Use
o Definition; indicator must be well-defined and the definition must be uniformly
o Validity; the indicator must e valid, reliable, and interpretable.
o Feasibility; the gather of information must be technologically feasible.
o Utility; The indicator should provide info that’s useful for decision-makers and can
be acted on as a whole.
• Canada’s Approach (in order of most easily defined to less easily defined)
o Health Status (such as prevalence of breast cancer)
o Non-medical determinants of Health (such as smoking rate, the number of
people that wear seat belts, etc.)
o Health system performance (wait times for knee replacement surgery, easiness
of finding a doctor, etc.)
o Community and health system characteristics (population density; the more
dense a population, the easier it is to access healthcare generally) o Equity (potential rate reduction, ie. If the income level of a community is
increasing, the potential to have access to health centres is also increasing)
• Graph; Cancer-related deaths
o Always consider what factors/indicators may be missing.
• Traditional indicators in pop. Health
o Mortality Rate; # of people who’ve died divided by the total people were at risk of
dying, a percent (crude death rate)
Ie. Standardized mortality ratio, age-specific mortality rate, case fatality
rate, perinatal mortality rate (feta and neonatal deaths), maternal mortality
rate, infant mortality rate (less than 1 year old), standardized mortality
rate (SMR) (proportional comparison to the numbers of deaths that would
have been expected if the population were of comparable age to other
o Poverty Line/Threshold
“Minimum level of income deemed necessary to achieve an adequate
standard of living”
Total cost of all essential resources a person needs for one year
Varies between countries and over time
Sometimes defined relative to income (EU defines as making 60% of
In developing countries, the biggest cost is shelter, such as mortgage
Canada’s LICOs (low income cut-offs); if you make under $25000, you’re
technically in poverty.
Relative poverty vs. absolute poverty (sometimes used to mean extreme
• If you don’t have two or more of the following, you’re in absolute
o Food, basic education, sanitation, safe water, health,
shelter, information, access to services
Every method to find it is flawed or biased
o Prevalence; number of cases
o Incidence; number of new cases over a period of time
Usually as a number per 1000 Measure of morbidity
Ie. HIV incidence fell from 7.6 per 1000 to 3.2 per 1000 from 1990-2000
Detection bias; simply by finding a disease you’re able to track more of it
o Child Health
Perinatal (5 months before and 1 month after) the time around birth
Infant Mortality (number that have died before 1 year)
Biggest killers of children (most o