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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

Chapter Two

Health Determinants, Measurements, and Trends


The importance of measuring health status

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

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

Figure 2.1: Key Determinants of Health


Key health indicators

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

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


Figure 2 3 infant mortality rate

Figure 2.3: Infant Mortality Rate


Figure 2 4 neonatal mortality rate

Figure 2.4: Neonatal Mortality Rate


Figure 2 5 under 5 child mortality rate

Figure 2.5: Under-5 Child Mortality Rate


Figure 2 6 maternal mortality rate

Figure 2.6: Maternal Mortality Rate


Key health indicators1

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 indicators2

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

  • 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

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 disease1

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

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

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

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


The global burden of disease1

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

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

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


The global burden of disease2

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 2.5: 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

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


The global burden of disease3

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 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


Chapter two

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

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 health1

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 health2

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 health3

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 health4

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

Figure 2.9: The Demographic Transition


Demography and health5

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

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


Progress in health status

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

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


Looking forward

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 forward1

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 forward2

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 forward3

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 forward4

Looking Forward

Emerging and Re-emerging Infectious Disease

  • Occurrence and impact difficult to predict

  • Pandemic flu

  • Anti-microbial resistance


Looking forward5

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

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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