Health Indicators

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International Development and Globalization
Sonia Gulati

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 die?  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 applied internationally. 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 population) 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 median income)  In developing countries, the biggest cost is shelter, such as mortgage payments  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 poverty) • If you don’t have two or more of the following, you’re in absolute poverty 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  Neonatal  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
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