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Chapter Two. Health Determinants, Measurements, and Trends. The Importance of Measuring Health Status. In order to address global health issues, we must understand: The factors that influence health status most The indicators used to measure health status

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Chapter Two

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Chapter Two

Health Determinants, Measurements, and Trends


The Importance of Measuring Health Status

In order to address global health issues, we must understand:

  • The factors that influence health status most

  • The indicators used to measure health status

  • The key trends that have occurred historically


Determinants of Health

  • The interconnected factors that determine an individual’s health status

  • Determinants include personal features, social status, culture, environment, educational attainment, health behaviors, childhood development, access to care, and government policy

  • Increasing attention is being paid to the “social determinants of health”


Figure 2.1: Key Determinants of Health


Key Health Indicators

Health status indicators are useful for:

  • Finding which diseases people suffer from

  • Determining the extent to which the disease causes death or disability

  • Practicing disease surveillance

    To perform these functions, it is important to use a consistent set of indicators


Table 2.1: Key Health Status Indicators

Source: Data from the Public Health Agency of Canada. What Determines Health. Available at: http://www.phac-aspc.gc.ca/ph-sp/determinants/ index-eng.php#determinants. Accessed November 19, 2010.


Figure 2.2: Life Expectancy at Birth, by World Bank Region, 2008


Figure 2.3: Infant Mortality Rate


Figure 2.4: Neonatal Mortality Rate


Figure 2.5: Under-5 Child Mortality Rate


Figure 2.6: Maternal Mortality Rate


Key Health Indicators

Terms

  • Morbidity- sickness or any departure, subjective or objective, from a psychological or physiological state of well-being

  • Mortality- death

  • Disability- temporary or long-term reduction in a person’s capacity to function

  • Prevalence- number of people suffering from a certain health condition over a specified time period

  • Incidence- the rate at which new cases of a disease occur in a population


Key Health Indicators

Classifications of Disease

  • Communicable disease- illnesses caused by a particular infectious agent that spread directly or indirectly from people to people, animals to people, or people to animals

  • Noncommunicable disease- illnesses not spread by an infectious agent

  • Injury- include road traffic injuries, falls, self-inflicted injuries, and violence, among other things


Vital Registration

  • Vital registration systems record births, deaths, and causes of death

  • An accurate system is key to having quality data on a population

  • Many low- and middle-income countries lack a vital registration system

  • Developing a system is progress towards understanding and addressing health problems


Measuring the Burden of Disease

  • Twp indicators used to compare how far countries are from a state of good health

  • Health-Adjusted Life Expectancy (HALE)- summarizes expected number of years to be lived in what might be termed the equivalent of good health

  • Disability-Adjusted Life Year (DALY)- a unit for measuring the amount of health lost because of a particular disease or injury


Measuring the Burden of Disease

DALY

  • “Health gap measure,” indicating losses due to illness, disability and premature death in a population

  • Gives a better estimate of the health of a population than death rate

  • Accounts for health conditions like mental illness that rarely cause death


The Global Burden of Disease

Important to understand:

  • Leading causes of illness, disability, and death in the world

  • Variations by age, sex, ethnicity, and socioeconomic status

  • Changes over time


Table 2.3: The 10 Leading Causes of Death and DALYs

Source: Adapted with permission from Lopez AD, Mathers CD, Murray CJL. The burden of disease and mortality by condition: data, methods, and results for 2001. In: Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJL, eds. Global Burden of Disease and Risk Factors. Washington, DC and New York: The World Bank and Oxford University Press; 2006.


Table 2.3: The 10 Leading Causes of Death and DALYs (cont.)


The Global Burden of Disease

Causes of Death by Region

  • Higher income countries tend to have a greater burden of noncommunicable disease

  • Lower income countries to have a greater burden of communicable disease

  • Africa and South Asia are set apart by their large burdens of communicable disease


Table 2.4: The Leading Causes of the Burden of Disease

Source: Reprinted with permission from Lopez AD, Mathers CD, Murray CJL. The burden of disease and mortality by condition: data, methods, and results for 2001. In: Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJL, eds. Global Burden of Disease and Risk Factors. Washington, DC and New York: The World Bank and Oxford University Press; 2006:91.


Table 2.4: The Leading Causes of the Burden of Disease (cont.)


The Global Burden of Disease

Causes of Death by Age

  • Children in low- and middle-income countries often die of communicable disease

  • HIV/AIDS and TB are among the leading causes of death among adults in low- and middle-income countries


Table 2.5: The 10 Leading Causes of Death in Children Ages 0-14, by Broad Income Group, 2001


Table 2.6: The 10 Leading Causes of Death in Adults 15-59, by Broad Income Group, 2001


The Global Burden of Disease

The Burden of Deaths and Disease Within Countries

In most low- and middle-income countries:

  • Rural people will be less healthy

  • Disadvantaged ethnic minorities will be less healthy

  • Women will suffer from their weak social positions

  • Poor people will be less healthy

  • Uneducated people will be less healthy


Risk Factors

  • Risk factor- an aspect or personal behavior or life-style, an environmental exposure, or an inborn or inherited characteristic, that, on the basis of epidemiological evidence, is known to be associated with health-related conditions considered important to prevent

  • Most important risk factors in low- and middle-income countries are malnutrition, high blood pressure and high cholesterol, smoking, and unsafe sex


Table 2.8:The Leading Risk Factors for the Burden of Disease, 2001, Low- and Middle-Income and High-Income Countries, Ranked in Order of Percent of Total DALY


Demography and Health

Population Growth

  • Majority of population growth will occur in low- and middle-income countries

  • Put pressure on the environment

  • Create need for more infrastructure and services


Demography and Health

Population Aging

  • Population of the world is aging

  • Implications for burden of disease because people will be living longer with morbidities and disabilities

  • Healthcare financing will be affected by change in ratio of working people to those over 65 years


Demography and Health

Urbanization

  • Majority of the world’s population lives in urban areas for the first time

  • Enormous pressure on urban infrastructure like water and sanitation


Demography and Health

The Demographic Divide

  • Highest income countries: low fertility, declining populations, aging populations

  • Lowest income countries: relatively high fertility, growing populations


Demography and Health

The Demographic Transition

  • Shift from pattern of high fertility and high mortality to low fertility and low mortality

  • Mortality declines due to better hygiene and nutrition

  • Population grows with younger share of population increasing

  • Fertility declines

  • Population growth slows and older share of population increases


Figure 2.9: The Demographic Transition


Demography and Health

The Epidemiologic Transition

  • Shift from burden of disease dominated by communicable disease to burden of disease dominated by noncommunicable disease

  • Most low-income countries are in ongoing transition so they face large burdens of communicable and noncommunicable disease


Figure 2.10: The Burden of Diseae by Group of Cause, Percent of Deaths, 2001


Progress in Health Status

  • Improvements in raising life expectancy and improving health not uniform across countries

  • Life expectancy in South Asia and sub-Saharan Africa lag that in other regions

  • Life expectancy in Europe and Central Asia changed little due to break-up of Soviet Union

  • Life expectancy in East Asia has increased dramatically due to rapid economic growth


Table 2.11: Life Expectancy and Percentage Gain in Life Expectancy, 1960-2008, by World Bank Region


Looking Forward

Economic Development

  • Economies of low-income countries need to grow in order to invest in health

  • Impact of economic development will depend on countries investing in areas that improve health such as water, sanitation, and education


Looking Forward

Scientific and Technological Change

  • Development of vaccines, drugs, and diagnostics

  • Country’s ability to adopt these changes will determine their effect on health


Looking Forward

Climate Change

  • Impact not entirely clear

  • Possible migration from places that become inhabitable

  • Adverse weather

  • Possible change in populations of disease vectors


Looking Forward

Political Stability

  • Necessary for long-term gains in health

  • Instability causes illness, disability and death as well as breakdown of infrastructure and services


Looking Forward

Emerging and Re-emerging Infectious Disease

  • Occurrence and impact difficult to predict

  • Pandemic flu

  • Anti-microbial resistance


Looking Forward

Projecting the Burden of Disease

  • Substantial changes from 2004 to 2030

  • Low- and lower-middle-income countries will shift away from communicable disease

  • Causes associated with aging will increase in importance

  • Mental health issues will increase in importance


The Development Challenge of Improving Health

  • Health usually increases as national income increases

  • Some countries have achieved higher life expectancies than their incomes would predict

  • This is possible with investments in nutrition, education, good hygiene, and low-cost services that have a high impact such as vaccination programs


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