INDICES OF COMMUNITY HEALTH Transcribed by: Alfonso Martin E.

Plantilla
Lectured by: Marlene R. Checa M.D. FPAFP Proofread by: Alexander Josef E. Dumlao

TOPIC OUTLINE HEALTHY CHILD DEVELOPMENT

 Identify the key determinants of health  Ways in which families take care of the infants and young
 Enumerate the different health indicators children
o Define Epidemiology  Relationship between nutritional status and their biologic
o Define Rate, Ratio, Morbidity, Mortality potentials as well as acquiring diseases
o Define & differentiate prevalence & incidence HEALTH SERVICES
 Most individuals would regard that health depends on:  Access and use of services that prevent and treat
access to HEALTH SERVICES. disease influences health.
DETERMINANTS OF HEALTH POLICY/GOVERNANCE
 Individual characteristics and behavior  The approach that governments take to different policies
 Social and Cultural Issues and programs in the health sector and in other sectors
 Education has an important effect on people’s health
 Environment
 Healthy Child Development DETERMINANTS OF HEALTH
 Health services
 Policy/Governance
 It is the interrelationships among these factors that
determine individual and population health.
INDIVIDUAL CHARACTERISTICS
 Genetic make up
 Sex
 Age
INDIVIDUAL BEHAVIOR
 Diet
 Physical activity 

 Alcohol, cigarette or other drug use HEALTH INDICATORS

SOCIAL AND CULTURAL ASPECTS
 Availability of resources to meet daily needs, such as
educational and job opportunities, living wages, or
healthful foods
 Social norms and attitudes, such as discrimination
 Provides the basis for describing and explaining disease
occurrence in a community
o Help to understand the burden of disease
 Provides a basis for developing, prioritizing and
evaluating public health programs
 Used to evaluate success of programs

HEALTH INDICATORS: EPIDEMIOLOGY

 Exposure to crime, violence, and social disorder 

 Social support and social interactions  The science concerned with the study of the factors
 Exposure to mass media and emerging technologies, determining and influencing the frequency and
such as the Internet or cell phones distribution of disease, injury, and other health related
 Socioeconomic conditions, such as concentrated events and their causes in a defined human population
poverty and also, the sum of knowledge gained in such a study.
(thefreedictionary.com)
 Quality schools
 Transportation options  A branch of medical science that deals with the
incidence, distribution, & control of disease in a
 Public safety
population. (Webster’s Dictionary)
ENVIRONMENT
EPIDEMIOLOGY: THREE AIMS
 Natural environment, such as plants, weather, or climate 

change
 Built environment, such as buildings or transportation
 Worksites, schools, and recreational settings
 Housing, homes, and neighborhoods
 Exposure to toxic substances and other physical
hazards
 Physical barriers, especially for people with disabilities
 Aesthetic elements, such as good lighting, trees, or
benches
EDUCATION
 A powerful determinant of health
 Brings with it knowledge of good health practices
 Provides opportunities, for gaining skills, getting better
employment, raising one’s economic status and
enhancing one’s social status.
 Whether
o To describe whether the burden of diseases or
health-related states (such as smoking rates) are
similar across different populations (descriptive
epidemiology)
 Why
o To identify why some populations or individuals are
at greater risk of disease (risk-factor epidemiology)
and hence identify causal factors
 What
o To measure the need for health services, their use
and effects (evidence-based-medicine) and public
policies (Public health) that may prevent disease –
what we can do to improve the health of the
population
 Helps in planning, implementing, monitoring & evaluation.
HEALTH INDICATORS o The average number of years a newborn baby
could expect to live if current mortality trends were
 It is important to use a standard set of indicators to
to continue for the rest of the newborn’s life
measure health status of a certain population /
o The higher the life expectancy at birth, the better
community
the health status of a country
SOURCES OF DATA
 Population Census – total process of collecting,
compiling and publishing demographic, economic and
social data pertaining, at a specified time or times, to all
persons in a country of delimited territory; done usually
every 10 years by National Statistics Office
 Sample Survey – collecting information from only a
subset of the population to yield necessary data, can
give accurate information within a shorter period of time
if planned and conducted properly
 Registries of Vital Events – continuous recording of
vital events like births, deaths, stillbirths, marriages,
divorces, adoptions and annulments as they occur in the
population
 Weekly Reports of the occurrence of Notifiable
Diseases – For surveillance and monitoring of important
communicable diseases.
 Morbidity and Mortality Statistics – Underlying cause
of death is the one used in reporting the cause of death.  Infant Mortality Rate
MEASURES OF DISEASE OCCURRENCE ARE BASED o The number of deaths of infants under age 1 per
ON: 1,000 live births in a given year
 Rates o A high IMR means low levels of health standards
o A measure of the frequency with which an event (poor maternal and child health care, malnutrition,
occurs in a defined population in a defined time poor environmental sanitation, deficient health
o It has a time dimension service delivery)
 Ratios Number of Deaths below 1 yr of age x 1,000
o Is a relative number expressing the magnitude Number of Live Births in a year
of one occurrence or condition in relation to
another
o The important difference between a rate and a
ratio is that for a rate, the numerator is included
in the population defined by the denominator
while in a ratio, the numerator and denominator
are usually separate and distinct quantities
RATIO
 Sex Ratio
Number of Males x 100
Number of Females
 Dependency Ratio
Number of persons aged 0-14 + 65 yrs & over x 100
Number of Persons aged 15 – 64
IMPORTANT FACTORS TO CONSIDER IN
INTERPRETING RATE AND RATIO
 The source of the numbers that entered into the  Neonatal Mortality Rate
numerator and denominator, how were they obtained?
o Often attributed to inadequate access to basic
 Do they represent an accurate count of the event under
medical care, during pregnancy and after delivery
study?
o The number of deaths to infants under 28 days of
 What is the time period involved? A week? Month?
age in a given year per 1,000 live births
Year?
 Does the rate obtained after analysis measure what it is Number of Deaths below 28 days x 1000
supposed to measure? Number of Live Births in a year
 Is the magnitude of the rate reasonable in relation to
 Child Mortality Rate (Under 5 mortality Rate)
what one may expect the rate to be?
o The probability that a newborn baby will die before
KEY HEALTH INDICATORS
reaching age 5
 Life Expectancy at Birth
Number of Deaths under 5 years old x 1,000
o Reflects the overall mortality level of a Number of Live Births in a year
population.
o Summarizes the mortality pattern that prevails
across all age groups – children& adolescents,
adults and the elderly.
 Maternal Mortality Rate
o Measure the risk of dying from causes
associated with childbirth
o Ideal denominator is the number of women but
since this number is unknown, the number of
live births has been adopted for practical
reasons
o Strongly correlated with the economic status of
a certain country
Number of deaths among women directly due
Pregnancy and childhood complications_ x 100,000
Total live Births
OTHER MORTALITY RATES
 Crude Death Rate (CDR)
o Measure the probability of dying in a populaton
Number of Deaths x 1,000
Total Population
 Proportionate Mortality Rate
o Diseases in the population, of different ages,
sex, occupation, etc.
o Useful for determining the order of importance

of cause of death in different age groups
Number of Deaths due to a certain cause x 1,000
Total Number of Deaths
 Swaroop’s Index
o The higher this rate the better is the health
status of the population because there is a
greater proportion of deaths who were able to
reach the age of 50 years
Number of Deaths 50 y.o. and above x 100
Total Number of Deaths (All causes)
 Case Fatality Rate
o Measures the lethality or risk of dying of a
disease or injury.
Number of Deaths from a particular disease x 1,000
Number of Cases of same disease
 Fetal Death Ratio (Stillbirth Rate)
Fetal Deaths 28 weeks & over gestation x 1,000
Total live Births
 Specific Death Rate
o Necessary to study in detail the mortality
conditions in a community
 Cause Specific Death Rate (CSDR)
o Mortality rate from specific diseases or
conditions; gives the rate of dying secondary to
specific diseases
Number of Deaths from a particular cause x 1,000
Total Population
OTHER MORTALITY RATES
 Sex Specific Death Rate
Number of Deaths among female/male x 1,000
Total Population female/male
 Age Specific Death Rate
Deaths from all causes in a particular age grp x 1,000
Total Population of same age group
 Age-and-Sex Specific Death Rate
Deaths in a particular age & sex group x 1,000
Total Population of same age & sex group
 Age-Sex & Cause Specific Death Rate
Deaths in a particular cause in sex & age group x 1,000
Total Population of same age & sex group
FERTILITY RATES
 Crude Birth Rate (CBR)
Number of live births in a year x 1,000
Total Population
 General Fertility Rate (GFR)
o More appropriate measure of fertility
o More specific rate than the CBR since births are
related to the segment of the population deemed to
be capable of giving birth
Number of live births in a year x 1,000
Number of women 15-44 yrs of age

HEALTH STATUS ALSO AFFECTED BY…
 Morbidity
 Sickness from a psychological or physiological state
of well being
 Prevalence
 Incidence

PREVALENCE
 Measures the proportion of existing cases of a disease in
the population at a specified period of time
 Answers the question: What proportion of the population
are ill with a particular disease?
 Influenced by the incidence and by the duration of the
condition, and provides a good way to indicate the
burden of disease in a population
 Prevalence is defined as the proportion (or %) with the
disease at a particular point in time.
Number with disease at particular time x 100
Total Number in Population at that time
POINT – PREVALENCE (PP)

 The proportion of the population that has the disease at a
single point in time
No. of existing cases of a disease at a point in time x 100
Total Population at a given point in time
INCIDENCE


 No. of persons in a population that developed a disease
(new cases) during specified period; used to describe
acute conditions
 2 observations = start, end
 This is a broad term & the figures in the numerator is
usually obtained from notification during an interval of
time, usually a year and hence are usually under-
enumerated
No. of new cases of a disease over a period in time x 1,000
Population at Risk
MGD’s AND HEALTH INDICATORS

REFERENCES:
 Epidemiology, Evidence-Based Medicine and Public
th
Health Lecture Notes 6 edition. Yoav Ben-Shlomo,
Sara T. Brookes, Matthew Hickman, 2013
 Millennium Development Goals
 Sustainable Development Goals
nd
 Global Health 101 2 edition. Richard Skolnik, 2012
 World Health Organization

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