4.

1 BASIC CONCEPTS AND DEFINITIONS OF HEALTH

 What is health mean?

 The WHO defines health as:
a “state of complete physical, mental, and
social well-being, not merely the absence of
disease or infirmity” (WHO, 1947).
, not the
objective of living; it is a positive concept,
emphasizing social and personal resources as well as
physical capabilities” (WHO, 1984).
 CONCEPT OF HEALTH
 An understanding of health is the basis of all the
health care.
 Health is not perceived the same way by all the
members of a community including various
professional groups (like biomedical scientists, social
scientists, health administrators, ecologists) giving
rise to confusion about the concept of health.
 Health has evolved over the centuries from the
concept of individual concern to a worldwide social
goal.
 CON’D

 The various changing concepts of health are as follows:

1. Biomedical concept.

2. Ecological concept.

3. Psychosocial concept.

4. Holistic concept.
 1. BIOMEDICAL CONCEPT:
 Traditionally health has been considered as an absence of the
diseases and if someone was free from disease, then that person
was considered healthy.
 This concept is known as biomedical concept, and it is based on the
“germ theory of the disease.” Health means “absence of disease.”
 The medical profession viewed the human body as a machine and
disease is an outcome of the breakdown of the machine, and one of
the doctor’s tasks was to repair the machine.
 This concept has minimized the role of the environment, social and
cultural determinants of the health.
 Developments in medical and social sciences led to the conclusion
that the biomedical concept of health was inadequate.
 Deficiencies in the biomedical concept gave rise to other
concepts.

 The ecologists put forward the concept of ecological

concept.

 Ecologists viewed health as a dynamic equilibrium

between man and his environment, and the disease as a
maladjustment of the human organism to environment.
 3. PSYCHOSOCIAL CONCEPT:

 Advances in social sciences showed that health is not only a

biomedical phenomenon, but one which is influenced by
social, psychological, cultural, economic and political
factors of the people concerned.

 These factors must be taken into consideration in defining

and measuring health.

 Thus health is both a biological and social phenomenon.

 4. HOLISTIC CONCEPT:

 The holistic model is a synthesis of all the above concepts.

Holistic concept recognizes the strength of social,
economic, political and environmental influences on health.
 It has been variously described as multidimensional process
involving the wellbeing of the person as a whole.
 The emphasis is on the promotion and protection of health.
 The holistic approach implies that all sectors of the society
have an effect on health, in particular, agriculture, animal
husbandry, food, industry, education, housing, public works
and other sectors.
 Health and medical statistics incorporate a variety of data
types.
 The most common statistics reported are vital (birth,
death, marriage, divorce rates), morbidity (incidence
of disease in a population) and mortality (the number of
people who die of a certain disease compared with the total
number of people).
 Other common statistical data reported are health care
costs, the demographic distribution of disease based on
geographic, ethnic, and gender variables, and data on the
socioeconomic status and education of health care
professionals.
 We define health statistics as:

 a “numerical data that characterize the health of a

population and the influences that affect its health.”

 These influences include the environment; genetic and

other biological characteristics; health services; community
attributes; and the political and cultural contexts.

 Health statistics provide information about aggregations of people,

institutions, organizations, or health events rather than information
about an individual person or event.
 PURPOSES OF HEALTH STATISTICS
 Health statistics fulfill essential functions for public
health, the health services system, and our society.
 Through health statistics, we gain a collective understanding
of our health, our collective experience with the health
services system, and our public health problems and
challenges.
 Health statistics provide the information upon
which we can base important public decisions at
the local, state, and national levels.
 Health statistics have three major uses.
 1. For creating fundamental knowledge about the health of
populations, influences on health, and interactions among
those influences.
 2. For developing information to guide health policy
development, assessment, and evaluation.
 3. For generating information to guide implementation,
targeting, evaluation, and refinement of health programs
and other interventions for populations and to guide
personal health decisions.
SCOPE OF HEALTH STATISTICS

 Many factors influence the health of a population.

 Health statistics is now being applied to:

a) Communicable diseases (infectious disease)

o Cause by pathogens (ex: virus, bacteria,…) that affect the

body.
a) Non-communicable disease

 Nutrition deficiency, Mental disorders

 Hypertension, Cancer , Injures

 Environmental hazards etc.

 HEALTH INDICATORS
 Health indicators are quantifiable characteristics of a
population which researchers use as supporting evidence for
describing the health of a population.
 Typically, researchers will use a survey methodology to
gather information about certain people,
 use statistics in an attempt to generalize the information
collected to the entire population,
 and then use the statistical analysis to make a statement
about the health of the population.
 Health indicators are often used by governments to guide
health care policy.
 CON’D
 A common example of a health indicator is life
expectancy.

 A government might have a system for collecting

information on each citizen's age at the time of death.

 This data about age at death can be used to support

statements about the national life expectancy, in which
case life expectancy would be a "health indicator".

 Life expectancy may be one of many "health indicators"

which collectively researchers would use to describe the
health of the population of the country.
 CHARACTERISTICS OF HEALTH INDICATORS

A health indicator which will be used

internationally to describe global health should
have the following characteristics:
1. It should be defined in such a way that it can be measured

uniformly internationally.

2. It must have statistical validity.

3. The indicator must be data which can feasibly be collected.

4. The analysis of the data must result in a recommendation

on which people can make changes to improve health.

 LIST OF HEALTH INDICATORS e..

 Health indicators are required in order to measure

the health status of people and communities.

 There are over 100 global health indicators.

 Some of the global core health indicators are:

1. Health status indicators
Life expectancy at birth: is the average number of years that a
newborn could expect to live if he or she were to pass
through life exposed to the sex- and age-specific death rates
prevailing at the time of his or her birth, for a specific year,
in a given country, territory or geographical area.
 CON’D

 Neonatal mortality rate: is the probability that a child born in a

specific year or period will die during the first 28 completed
days of life if subject to age-specific mortality rates of that period,
expressed per 1000 live births.
 Infant mortality rate: is the probability that a child born in a
specific year or period will die before reaching the age of 1 year,
if subject to age-specific mortality rates of that period, expressed as
a rate per 1000 live births.
𝐼𝑀𝑅

𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠 𝑎𝑚𝑜𝑛𝑔 𝑐ℎ𝑖𝑙𝑑𝑟𝑒𝑛 < 1 𝑦𝑒𝑎𝑟 𝑜𝑓 𝑎𝑔𝑒 𝑟𝑒𝑝𝑜𝑟𝑡𝑒𝑑 𝑑𝑢𝑟𝑖𝑛𝑔 𝑎 𝑔𝑖𝑣𝑒𝑛 𝑡𝑖𝑚𝑒 𝑝𝑒𝑟𝑖𝑜𝑑
= ∗ 1000
𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑙𝑖𝑣𝑒 𝑏𝑖𝑟𝑡ℎ𝑠 𝑟𝑒𝑝𝑜𝑟𝑡𝑒𝑑 𝑑𝑢𝑟𝑖𝑛𝑔 𝑡ℎ𝑒 𝑠𝑎𝑚𝑒 𝑡𝑖𝑚𝑒 𝑝𝑒𝑟𝑖𝑜𝑑

 For example, Consider the infant mortality rate in 2003. That year, 28,025
infants died and 4,089,950 children were born, for an infant mortality rate of
6.851~7 per 1000.
 Maternal mortality rate: is the annual number of female deaths
from any cause related to pregnancy or its management (excluding
accidental or incidental causes) during pregnancy and childbirth or
within 42 days of termination of pregnancy, irrespective of the
duration and site of the pregnancy, expressed per 100 000 live births,
for a specified time period.

𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠 𝑎𝑠𝑠𝑖𝑔𝑛𝑒𝑑 𝑡𝑜 𝑝𝑟𝑒𝑔𝑛𝑎𝑛𝑐𝑦 𝑟𝑒𝑙𝑎𝑡𝑒𝑑 𝑐𝑎𝑢𝑠𝑒𝑠 𝑑𝑢𝑟𝑖𝑛𝑔 𝑎 𝑔𝑖𝑣𝑒𝑛 𝑡𝑖𝑚𝑒 𝑖𝑛𝑡𝑒𝑟𝑣𝑎𝑙
MMR= 𝑋100,000
𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑙𝑖𝑣𝑒 𝑏𝑖𝑟𝑡ℎ𝑠 𝑑𝑢𝑟𝑖𝑛𝑔 𝑡ℎ𝑒 𝑠𝑎𝑚𝑒 𝑡𝑖𝑚𝑒 𝑖𝑛𝑡𝑒𝑟𝑣𝑎𝑙

Adolescent fertility rate: is the annual number of births to women

aged 15-19 years per 1,000 women in that age group. It is also referred
to as the age-specific fertility rate for women aged 15-19.
 CON’D

 The crude birth rate: is the annual number of

live births per 1,000 population.

 Note: The numerator is the number of live births

observed in a population during a reference period
and the denominator is the number of person-years
lived by the population during the same period.

𝐵𝑖𝑟𝑡ℎ𝑠 𝑖𝑛 𝑎 𝑦𝑒𝑎𝑟
𝐶𝐵𝑅 = ∗ 1000
𝑃𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛 𝑎𝑡 𝑡ℎ𝑒 𝑚𝑖𝑑 𝑦𝑒𝑎𝑟
 2. RISK FACTORS INDICATORS

 Incidence of low birth weight among newborns: is the

percentage of live births that weigh less than 2500 g.

 Anemia prevalence in children: Percentage of children aged

6−59 months with a hemoglobin level of less than 110 g/L,
adjusted for altitude.

 Overweight and obesity in adults: is the percentage of

adults (18+ years) who are overweight (defined as having a
BMI ≥ 25 kg/m2) and obese (defined as having a BMI ≥ 30
kg/m2).
 Raised blood pressure among adults: is the age-standardized
prevalence of raised blood pressure among persons aged 18+
years (defined as systolic blood pressure ≥ 140 mmHg and/or
diastolic blood pressure ≥ 90 mmHg), and mean systolic blood
pressure.
 Note: Numerator: Number of respondents with systolic blood
pressure ≥ 140mmHg or diastolic blood pressure ≥ 90mmHg.
Ideally three blood pressure measurements should be taken and
the average systolic and diastolic readings of the second and third
measures should be used in this calculation.
 Denominator: All respondents of the survey aged 18+ years.
 CON’D

 Exclusive breastfeeding rate: is the percentage of infants

0–5 months of age (<6 months) who are fed exclusively with
breast milk.
3. Service coverage indicators
 Contraceptive prevalence rate: is the percentage of
women aged 15−49 years, married or in union, who are
currently using, or whose sexual partner is using, at least
one method of contraception, regardless of the method used.
 Adolescent fertility rate: is the annual number of births
to women aged 15-19 years per 1,000 women in that age
group. It is also referred to as the age-specific fertility rate
for women aged 15-19.
 Immunization coverage rate: is the percentage of the
target population that has received the last
recommended dose for each vaccine recommended in the
national schedule by vaccine. This should include all
vaccines within a country’s routine immunization
schedule (e.g., Bacillus Calmette–Guerin (BCG); polio;
pneumococcal conjugate vaccine (PCV); rotavirus;
diphtheria, tetanus, pertussis-Hepatitis B-Haemophilus
influenzae type B vaccine (DTP-HepBHib); measles
(MCV); rubella; human papilloma virus (HPV); tetanus
toxoid (TT); influenza; and others as determined by the
national schedule).
 CON’D

 Note: Numerator: The number of individuals in the target group

for each vaccine that has received the last recommended dose
in the series. For vaccines in the infant immunization schedule,
this would be the number of children aged 12–23 months who
have received the specified vaccinations before their first
birthday.
 Denominator: The total number of individuals in the target
group for each vaccine. For vaccines in the infant immunization
schedule, this would be the total number of infants surviving to
age one.
 SUMMARY MEASURES (RATIO, PROPORTION AND RATE)
Summary Measures

 Public health questions are about populations.

 Information about population characteristics is often

summarized in an index.

 Changes in population characteristics can be assessed by

comparing summary measures.
 INDICES USED TO SUMMARIZE INFORMATION

A ratio can be written as one number divided by

another (a fraction) of the form a/b.
 Both a and b refer to the frequency of some event or
occurrence.
Properties of Ratios
 Often a ratio R = a/b is rescaled by multiplying by a
constant k.
 Where k is a number such as 10, 100, 1,000, or 10,000.
R is always > 0.
R may or may not have units.
 CALCULATION AND INTERPRETATION OF AN ODDS RATIO

 Example: Table 1 shows Labor Force Participation of Males

and Females 15 Years and Over in Tepi, 1990.
Labor Force Participation Males Females Total
In the Labor Force 188,631 165,843 354,474
Not in the Labor Force 58,935 105,537 164,472
Total 247,566 271,380 518,946
 CON’D

.
 PROPORTION

A proportion is a ratio in which the numerator is a

subset (or part) of the denominator and can be
written as a/(a+b).
 PROPERTIES OF PROPORTIONS
P takes on values between 0 and 1 (p is a fraction).

P has no units.

P may be multiplied by a constant k.

 Where k is a number such as 100, 1,000, or 100,000.

Example: Proportionate mortality: In 1995, 53% of

all deaths in Africa were children under age 5.

p = 0.53 = 53% = 53 per 100 = 530 per 1,000.

 RATE
A rate is a ratio of the form a*/ (a+b) with time
dimenssion.
 a* = the frequency of events during a certain time period and
 a+b = the number at risk of the event during that time period.

 A rate may or may not be a proportion.

Properties of Rates
 The calendar time period is the same in both the
numerator and denominator of a rate.

A rate expresses the relative frequency of an event

per unit time (“risk”).
 CON’D
 The difference between Ratios, Proportions, and
Rates is:
A proportion and rate are always a ratio
 A rate may or may not be a proportion.