Transcript WHO's Activities on Measuring Health Status Health Statistics and Informatics Health Statistics and Informatics.

WHO's Activities on Measuring
Health Status
Health Statistics and Informatics
Health Statistics and Informatics
Areas of work
• Surveys
• Development of standardised health survey
modules
• Burden of disease
Health Statistics and Informatics
WHO - World Health Surveys
WHS 2002/03
70 SURVEYS in 70 countries
Household - long : 53
Household - short: 13
CATI :
4
The boundaries and names shown and the designations used on this map do not
imply the expression of any opinion whatsoever on the part of the World Health
Organization concerning the legal status of any country, territory, city or area or of
its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted
lines on maps represent approximate border lines for which there may not yet be
full agreement.
© WHO 2002. All rights reserved
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SAGE - INDEPTH
•China
•India
•Russia
•Mexico
•South Africa
•Ghana
•Kenya
•Tanzania
•Bangladesh
•Viet Nam
•Indonesia
The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of
the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation
of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. © WHO
2005. All rights reserved
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Current Status
• Data collection expected to be completed at all
sites by March 2009
• Data collection completed at all eight INDEPTH
sites
• Data sets in public domain by mid 2010
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Future directions
• Longitudinal follow up
• Improve understanding of non-fatal health outcomes / disability determinants
• Continue to develop methods to improve measurement, e.g., health
states, risk factors, effect of interventions
• Develop standard survey modules for health
• Link survey to demographic surveillance data – INDEPTH
• Promote use of methods in other international studies
• Create a data collection platform to monitor health trends and
determinants over time
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Standardised Health Modules objectives
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To provide easy access to standardized and validated survey questions and
modules, including those for the collection of biomarkers, with systematic
documentation
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To enhance harmonization of survey modules between international and
national surveys by developing common standards for health survey modules
and joint standards for health expenditure modules in surveys
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To make survey modules core indicator driven, and define minimum
contents
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To facilitate the establishment of a survey module driven approach to
country (health) surveys, in line with national plans and data needs
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Standardised Health Modules rationale
• Generate comparable data over time and between populations
• Limit the application of poorly tested survey modules and questions,
often driven by the flavour of the day
• Promote a more flexible system of survey implementation
• More critical and systematic assessment of the utility, reliability and
validity of survey questions
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Standardised Health Modules - topics
Subject areas
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Mortality
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Child mortality: birth history, recall births and deaths
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Maternal & Adult mortality: sibling history, recent deaths
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Causes of death: verbal autopsy, death certificates
• Morbidity & health states
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Health states: self reported health in specific domains
Chronic conditions (diabetes, heart disease, asthma, COLD,
arthritis, cancers, depression/mental conditions): recall
diagnosis, symptoms with algorithms, biological and clinical
testing
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HIV/AIDS
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Acute diseases: recall last 2 weeks (diarrhoea, respiratory
illness -mostly children); malaria
Intervention coverage
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MCH preventive interventions: immunization coverage,
maternal and neonatal care, PMTCT, FP etc.
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MCH treatment interventions: recall treatment practices
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Chronic conditions: recall treatment practices
Risk factors and determinants
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Risk factors children: water and sanitation, nutritional
status/feeding practices, indoor air pollution etc.
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Risk factors adults: smoking, overweight, dietary recall, sexual
behaviour, alcohol use, physical exercise
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Socioeconomic and cultural determinants: wealth, income,
education, ethnicity, religion
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Violence
Health systems
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Health expenditure: income, detailed expenses on health in
last year
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Responsiveness: self reported perception and satisfaction
Biomarkers
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Existing modules
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Birth history
Antenatal and delivery care / maternal and neonatal care
Birth history
Verbal autopsy
Family planning; fertility preferences
Immunization
Child morbidity and treatment
Child nutrition and feeding patterns
Maternal nutrition
Adult Chronic conditions and treatment
Health service utilization
HIV/AIDS; Malaria
Violence against women
Maternal mortality – sibilinghood
Etc.
Indicators
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Specific set of questions required for each indicator
Standardised Health Modules process
1.
Define the purpose, indicators and analytical dimensions of the module
2.
Review the literature with regard to measurement strategies for the outcome of interest with
specific regard to strengths and weaknesses of different approaches, their reliability and validity
3.
Build a repository of items from existing questionnaires including item wording, response
options, accompanying interviewer instructions and training guidelines, and other technical
documentation as appropriate
4.
Do a systematic comparison of items across different instruments to produce cross-walks across
different surveys and other modes of data collection
5.
Document the similarities and differences in the method used for data collection – including
mode of administration, sampling design, level of data collection, target population and
respondent characteristics
6.
Develop a standard and consistent set of minimum questions for a given topic module and if
appropriate a second more detailed set of questions
7.
Produce modules with a set of questions which embody best practice in the area accompanied
by information on routing, mode of interview, editing instructions and a basic tabulation plan
8.
Develop a testing protocol to demonstrate the utility, feasibility, reliability and validity of items
for each module.
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Global burden of Disease (GBD)
A standardized framework for integrating all
available information on mortality, causes of
death, individual health status, and conditionspecific epidemiology to provide an overview of
the levels of population health and the causes
of loss of health
• Consistent, comprehensive descriptive
epidemiology
• Common metric or summary measure
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Disability Adjusted Life Years
DALY = YLL + YLD
Time is used as the common metric
for mortality and health states
YLL Years of life lost due to mortality
YLD Equivalent years (of healthy life) lost due to
disability
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Years Lived With disability
YLD = I x L x DW
YLD =
I=
DW =
L=
Years of life lived with disability
Number of incident cases in the population
Average disability weight
Average duration of disability [years]
4 cases of mild mental retardation (DW=0.36) due to lead exposure
in early childhood :
4 x 0.36 x 77.8 years = 112 YLD
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The DALY quantifies "health"
• The DALY is now conceptualized as quantifying "health" not
the goodness of health (the original conceptualization) or
wellbeing/QoL
• Health conceptualized in terms of human functioning
capacities in a set of domains/dimensions of health
• Disability is seen as synonymous with loss of health
• Decrements in health are decrements in functioning capacity
in one or more health domains
• Above a certain threshold in a domain, improvements may
be seen as "talent" rather than increasing "health"
• Does health end at the skin? What about aids?
• GBD considers some aids close to the skin as improvements
in health (contacts, glasses, hearing aids, basic mobility aids)
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GBD Goals
• Measure loss of health due to comprehensive set of
disease, injury, and risk factor causes in a
comparable way
• Measure population health for the world, and for a
set of regions
• Decouple epidemiological assessment and advocacy
• Inject non-fatal health outcomes into health policy
debate
• Use a common metric for BOD assessment and
intervention analysis that combines mortality and
non-fatal outcomes
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Ten leading causes of burden of disease,
world, 2004 and 2030
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