Health indicator

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Health indicator is a metric that is used to measure health or/and welfare. There are several indicators available, for a variety of purposes.

Question

What health indicators exist and in which situations each of them are useful?

Answer

Disability-adjusted life year
Use when you want to combine death and disease, or impacts of several different diseases (especially when some are mild and some severe).
Quality-adjusted life year
Use when you want to combine death and suffering or lack of functionality, especially when the health outcomes are such that are not easily found from health statistics such as disease diagnoses.
Number of cases of death or disease
Use when the health impact is predominantly caused by a single outcome or when there is no need to aggregate different outcomes into a single metric. This is an easily understandable concept by lay people.
Life expectancy
Use when you want to describe public health impacts to a whole population and possibly its implications to the public health system. This is also a useful indicator if you want to avoid discussions about "what is premature" or "everybody dies anyway".
Welfare indicators
Use when you want to describe impacts on welfare rather than disease or health. There are a number of welfare indicators, but none of them has become the default choice. Consideration about the case-specific purpose is needed.

Rationale

DALY

Main article: Disability-adjusted life year

Disability-adjusted life year is a summary metric where potential years of life lost are added up with years of life lost due to disability:

DALY = YLL + YLD

Years of life lost is a product of number of cases of a disease (N), average duration of an incidence (L) of the disease, and disability weight describing the severity of the disease (D). So,

DALY = YLL + \sum_i N_i L_i D_i,

where i is an index for all diseases considered. See also the Wikipedia article about Disability-adjusted life year.

QALY

Main article: Quality-adjusted life year

Quality-adjusted life year is similar to disability-adjusted life year. The main difference is that instead of calculating cases of particular diseases, people's quality of life is evaluated using a typically five-dimensional quality indicator about e.g. functionality, pain, anxiety. See also the Wikipedia article about Quality-adjusted life year.

Number of cases

Number of cases of disease or death is a straightforward and easily understandable indicator. There are several ways of estimating it, and some of them have been described in Attributable risk. Other methods exist as well, e.g. additional cases may be estimated by comparing typical numbers of disease to the increased numbers during an epidemic.

Life expectancy

Main article: Life expectancy.

Life expectancy is a measure of the average expected lifetime given current conditions and risk factors. It is estimated by calculating survival function of all subsequent age groups. It is useful for population-level comparisons and policy discussions. However, it is a problem that estimates about absolute differences due to specific risk factor are so small that they appear meaningless even if they are important for the particular population or situation.

Welfare indicators

National sets of indicators:

  • Measures of Australia’s progress
  • Canadian Index of well-being
  • U.S. Key National Indicators Initiative (web-based database)
  • Measuring Ireland’s Progress
  • UK.s Quality of Life Counts

International sets of indicators:

  • UN: Millennium Development Goals Indicators
  • Eurostat: Sustainable Development Indicators
  • EU strategy for social protection and inclusion indicators (14)
  • OECD Factbook -> coming up: Handbook of Measuring Progress

Single indicators:

  • The Genuine Progress Indicator
  • Human Development Index - Human Poverty Index
  • The Measure of Economic Welfare
  • Index of Sustainable Welfare
  • WISP (World Index for Social Progress)
  • Composite Learning Index
  • Happy Planet Index
  • Measure of Domestic Progress (NEF)
  • Sustainable National Income (SNI)
  • OECD; Handbook on Constructing Composite Indicators (2005)

See also

References