HECO: Health Economics THE DETERMINANTS OF HEALTH (health indicators) AND AN OVERVIEW OF DEMOGRAPHY

HEALTH
It has been defined by the World Health Organization (WHO), as: the state of mental, physical and social well being, and does not merely connote the absence of illness.

HEALTH
derived from the word heal (hael) which means whole , signaling that health concerns the whole person and his or her integrity, or well-being

HEALTH
absence of symptoms in an individual may not necessarily connote a healthy condition (purpose of further medical examination/lab tests.) the concept of varying degrees or states of health (multi-factorial phenomenon) Difficult to both qualify and quantify.

DIMENSIONS OF HEALTH

ENVIRONMENT SOCIETAL

Physical Emotional

Mental Social

Spiritual Sexual

HEALTH ECONOMICS
Deals with the manipulation of factors that should be able to give people BETTER HEALTH Since it s a multi-factorial phenomenon, various aspects to manipulate it. Questions like What determines health? and What factors influence health ?

Underlying socio-economic, demographic, and cultural factors Individual

Determinants of Health: Major Effects and Intervention Points

Proximate Factors Health Outcomes

Underlying SocioEducation Economic, Occupation Demographic, and Health benefits, Cultural Factors
Attitudes Household Income/wealth Age-gender composition Social network Community Ecological climate Markets & prices Transportation size, structure, and distribution Social structure and organization

Age, gender

Health Care Services Environmental Contamination Nutrient Dietary intake Fertility Injury

Mortality Morbidity Nutritional Status Disability

DEMOGRAPHY
the mathematical & statistical study of the size, composition & spatial distribution of human populations & of changes over time in these aspects through the operation of 5 processes of:
1. Fertility 2. Mortality 3. Migration 4. Marriage 5. Social mobility

Uses of DEMOGRAPHY
To determine the number & distribution of a population in certain area for planning, priority setting & for purposes of fund allocation. To determine growth (or decline) & dispersal of population in the past. To establish a casual relationship between population trends & various aspects of social organization. To predict future developments & their possible consequences.

Describing the Population Composition A. Sex Composition 1. Sex Ratio 2. Sex Structure B. Age Composition 1. Median Age 2. Dependency Ratio C. Age and Sex Composition 1. Population Pyramid

Sex Composition 1. Sex Ratio

Compares the number of males to the number of females Sex Ratio = _number of males_ x 100 number of females
Ex: In the 1990 Philippine census, 30, 745,341 males and 30,115,929 females were enumerated. Sex Ratio = 30, 745,341 x 100 = 102.08 = 102 30,115,929

Interpretation: In 1990, there were 102 males for every 100 females in the Philippines

Sex Composition 1. Sex Structure

Compares the sex ratio across different categories/levels of another characteristic Ex: Sex structure across urban-rural classification or across different age groups Interpretation: There is usually a higher sex ratio in the younger age groups and lower sex ratio at the older age groups.

Sex Composition 1. Sex Structure

Age Composition 1. Median Age

The value which cuts-off the upper 50% and lower 50% of the ages of the population. Used to gauge whether the population is young or old Ex: The median age of the Filipinos was 15.8 years in 1970 and 19 years in 1990.

Age Composition 2. Age-Dependency Ratio

= Pop 0-14 yo + Pop 65 yo x 100 Pop 15-64 yo The computed value represents the number of dependents that need to be supported by every 100 persons in the economically-active groups. Age groups Number Percent Ex: 0-14 24,004,586 39.5 15-64 34,629,959 57.1 65 & over 2,063,445 3.4

Age Composition 2. Age-Dependency Ratio = 24,004,586 +2,063,445 x 100 = 75.3

34,629,959 Interpretation: In the 1990, every 100 persons in the economically-productive age groups had to support 75 dependents.

Age & Sex Composition 1. Population Pyramid

A graphical presentation of the age and sex composition of the population Also enables one to explain and describe the demographic trends of the population in the past.

Age & Sex Composition 1. Population Pyramid

Age & Sex Composition 1. Population Pyramid

Age & Sex Composition How to construct a Population Pyramid?

1. Compute the percentage of the population falling in each age-sex group using the total population, that is, males and females combined) as the denominator. 2. Each group is represented by a horizontal bar. The first bar representing the youngest age group is drawn at the base of the pyramid. 3. The bars for males are traditionally presented on the left side of the central vertical axis while bars for females are presented on the right side. 4. The length of each bar corresponds to the percent (%) of the population falling in the specific age and sex group being plotted.

Age & Sex Composition 1. Population Pyramid

HEALTH INDICATORS
Quantitative measures Describe & summarize various aspects of health status of the population Usually expressed as ratios, proportions or rates

HEALTH INDICATORS
USES Determine factors that may contribute to causation & control of diseases Identify public health problems & needs Indicate priorities for resource allocation (health economics) Monitor health program implementation Evaluate health programs

Crude Birth Rate (CBR)

Measures how fast people are added to the population Crude rate because the denominator is not the population at risk

Crude Birth Rate (CBR)

CBR = no. of registered livebirths in year x 1000 mid-year population CBR = 2,036,944 x 1000 = 28.4/1000 71,723,373 Interpretation: CBR 45 l.b./1000 pop/yr high fertility rate CBR 20 l.b./1000 pop/yr low fertility rate

Crude Death Rate (CDR)

Measures rate at which mortality occurs in a given population
CDR = total deaths in one year x 1000 total midyear population CDR = _437,513_ x 1000 = 6.1/1000 pop 71,723,373 (US CDR = 9.2/1000)

General Fertility Rate (GFR)

GFR = # registered l.b. in a year
midyear population women 15-44 yo

x 1000

GFR = _1,658,568_ x 1000 1,563,836 Interpretation: GFR = 200 l.b./1000 pop/yr high fertility rate GFR = 60 l.b./1000 pop/yr low fertility rate

MORTALITY INDICATORS
CDR = total deaths in one year x 1000 total midyear population
Cause-of-death rate = # deaths in a specific cause x 1000 midyear population -- for determining the leading causes of mortality

MORTALITY INDICATORS
INFANT MORTALITY RATE A sensitive index of the health conditions of the general population!!! = total deaths < 1 yo x 1000 # of l.b. Poor populations 60-150 deaths per 1000 births per year Severe conditions 200 deaths per 1000 births per year

MORTALITY INDICATORS
NEONATAL MORTALITY RATE (< 28 days old) POST-NEONATAL MORTALITY RATE (28 days old to <1 yo) PERINATAL MORTALITY RATE (28 weeks gestation to 7 days) MATERNAL MORTALITY RATE MMR = # pregnancy-related deaths in year x 1000 # of l.b. in the same year

MORTALITY INDICATORS
SWAROOP S INDEX
 a special kind of proportionate mortality ratio  a sensitive indicator of the standards of healthcare  Developed countries have higher compared to developing

= # deaths 50 yo in a year x 100 total # of deaths

MORTALITY INDICATORS
CASE FATALITY RATE
 how much of the afflicted die from the disease  a higher CFR means more fatal disease  the killing power of a disease  the probability of dying of a certain disease

CFR = # deaths due to a disease x 100 # of cases of the disease

MORBIDITY INDICATORS
PREVALENCE PROPORTION (ratio)
 Measures the frequency of existing disease (cases)  Measure the burden of the disease to the community  Assess the public health impact of a disease  Projection of medical care needs  Proportion with the disease at a point in time  point in time : calendar time, birth, employment, retirement

PR = # cases at a point in time x 1000 # of persons examined

MORBIDITY INDICATORS
PREVALENCE PROPORTION (ratio)
Example 1: In a large industrial concern employing 10,000 people on January 1, 2005, 50 people have diabetes. An additional 100 cases of diabetes were diagnosed between January 1, 2005 and January 1, 2006. During the year, no employees moved out of the company due to retrenchment or retirement; neither were new employees hired. The prevalence of diabetes as January 1, 2005 is:

PR = _50_ x 1000 = 5 cases/1000 employees 10,000

MORBIDITY INDICATORS
INCIDENCE
 Measures the occurrence of new cases, episodes, events  For identifying etiologic factors  2 types of incidence measures
Cumulative incidence or incidence proportion Incidence density

 Indicator of trend  Evaluate program effectiveness  Associated to RISK = the probability that a person will develop within a specified period of time

MORBIDITY INDICATORS
INCIDENCE
1. Cumulative incidence or incidence proportion  Proportion of disease free individuals who contract the disease within a specified period of time  The average risk of developing the disease

CI = # cases that developed during the period x 1000 # of persons followed up (DISEASE-FREE/AT RISK!)

MORBIDITY INDICATORS
INCIDENCE
1. Cumulative incidence or incidence proportion
Still using Example 1: In a large industrial concern employing 10,000 people on January 1, 2005, 50 people have diabetes. An additional 100 cases of diabetes were diagnosed between January 1, 2005 and January 1, 2006. During the year, no employees moved out of the company due to retrenchment or retirement; neither were new employees hired. The prevalence of diabetes as January 1, 2005 is:

CI= _100_ x 100 = 1% per year 9,950

MORBIDITY INDICATORS
INCIDENCE
2. Incidence Density (ID)  Rate at which new cases occur  Denominator can either be ave. pop x followup period or the midyear pop

ID = # cases that developed during the period x F ave. pop x duration of followup ID = # cases that developed during the period x F mid year pop

MORBIDITY INDICATORS
INCIDENCE
2. Incidence Density (ID)

Example: new cases of Leprosy = 5,265 (1 yr followup) mid year pop = 71,960, 594
ID = # cases that developed during the period x F ave. pop x duration of followup ID = # cases that developed during the period x F mid year pop

ID = 7.3/100,000 pop Interpretation: On the average, 7 out of 100,000 pop will develop leprosy during a one year period

Underlying socio-economic, demographic, and cultural factors Individual

Determinants of Health: Major Effects and Intervention Points

Proximate Factors Health Outcomes

Underlying SocioEducation Economic, Occupation Demographic, and Health benefits, Cultural Factors
Attitudes Household Income/wealth Age-gender composition Social network Community Ecological climate Markets & prices Transportation size, structure, and distribution Social structure and organization

Age, gender

Health Care Services Environmental Contamination Nutrient Dietary intake Fertility Injury

Mortality Morbidity Nutritional Status Disability

Proximate factors and health programs developed

Proximate factors Health Care Service Utilization Environmental Contamination Nutrient Dietary Intake Fertility Injury

Health Programs Developed OPLAN Bakuna with Jollibee, OPLAN Alis Disease Anti-pollution Campaign, Worker Health and Safety Program Barangay Day Care Centers, Vitamin A Campaign Responsible Parenthood Information Drive Dont Drink and Drive

Health outcome before the health program

Compare Health outcome after the health program

Health Program

Example
A: Individual Level
Occupation as a >>> Exposure to mining >>> increased coal miner (Occupying as contamination determinant) contaminants (Environmental outcome) as proximate determinant) incidence of worker s lung disease (Health Status/ underlying

Example
B. Household Level
Low household Income >>> Poor nutritional >>>> Poor nutritional intake status (low weight, height)

(Income/Wealth as proximate

(Nutritional intake as (Health status/ underlying Outcome) determinant) determinant)

Example
C. Community Level
Poor transportation >>> Poor health care >>> More deaths in transportation service utilization the area network

(Transportation utilization as a

(Healthcare service (Health Status/ as underlying Outcome) determinant) proximate factor

Relationship Of health and Economic

Improvement in Health status

More resources allocated for health

Improvement in worker productivity

?
Contributes to better economy