Week 1
Why do we measure health?
There are many reasons to measure health, and this include:
1. Identify priority health issues that we should then allocate funding and resources.
This includes looking at the prevalence of a disease in population, and how it has
changed, and for different social/cultural groups.
Looking at the engagement of behaviours, e.g. Smoking, and if behaviours have
changed from policies. Determining if more funding needs to be allocated to a
particular disease, particular group, or behaviour.
2. Monitor progress - by using data to determine if health outcomes have improved or
worsened. To determine if differences in progress exist between different
groups/regions/cultures.
3. Re-evaluate health promotions - determine if government initiatives are improving
health of society. Evaluations are done before, during, and after implementing
health policies and behaviours. This provides more information about if a policy will
improve a particular health issue.
Health can be measured using epidemiology. Epidemiology is the study of patterns and
causes of health and disease in populations, and the application of this study to improve
health.
Decision making
The government in power at the time, develops programs on a local, national, and
international level, and also allocates funding to primary health care sectors (GP's),
secondary health care sectors (hospitals), and tertiary health care sectors (specialists).
Evaluation programs and determining their effectiveness helps governments make decisions
about funding.
• Following same group of people over time to see improvements in a program, e.g.
Measure up campaign
• Observing effect of an intervention, e.g. Trials of munch or move.
If policies and programs are effective, funding will continue to ensure that the services of a
policy/initiative continue to support the community.
If the policies/programs are not effective, governments can decide to remove funding, and
allocate it elsewhere.
Incidence and prevalence
,Incidence is the number of new cases of an illness/disease event at a given period of time. It
is used for more acute short term diseases such as COVID-19 or influenza.
• Incidence rate is the most precise measure which measures the rate at which new
cases occur
• Cumulative incidence is a measure of the occurrence of the disease within the
specified time.
Prevalence is the number of proportion of cases/instances in a population at a given time.
For example, in cancer, the prevalence refers to the number of people alive who have been
diagnosed with cancer in a certain period (1,5, 10 years). Prevalence is used to measure
disease that can last a long period of time.
• Point prevalence is prevalence that occurs at a specific point in time. E.g. Number of
vehicle accidents on the 31st December
• Period prevalence refers to prevalence in a certain period of time. E.g. Number of
vehicle accidents between January and December
Life expectancy
The number of years of life, on average, remaining to an individual at a particular age, if
death rates do not change.
The most common used measure is life expectancy at birth. It is expressed as the number of
years of life a person born today is expected to live.
In Australia, there has been a steady increase in the life expectancy between 1886-2016.
• In 2016, the life expectancy at birth was 80.4 years for males, and 84.6 years for
females.
• In this period, females have on average lived longer than males.
• Between 1956-1986 there was a larger gap between females and males life
expectancy. Possible reasons for this was World War 2. After 1986 this gap closed.
This type of data is useful in seeing trends. The increasing trend in life expectancy can be
attribute to medical advances such as medicine, surgery, and vaccination.
On an international level, Australia has quite a high life-expectancy. This has been seen since
1990, and has gradually increased life-expectancy since 1990, alongside Japan and Norway.
Other countries that have lower life-expectancy will have higher mortality rates.
Mortality
,Mortality refers to the number of deaths in a population, in a given period. Can be
measured for any population, national, social, or cultural level.
Pre-mature mortality is the potential years of life lost before the age of 70. In aboriginals,
the life expectancy is around 60, so they have higher rates of pre-mature mortality.
Infant mortality (IFR) is the number of deaths of children <1yo, per 1000 live births, in a
calendar year.
• There has been a significant decline in the number of infant mortalities between
1899-2009. Improvements in pre-natal care and maternal care have contributed to
this.
• In addition, the infant mortality rates in indigenous populations is higher. Although
their IFR has decreased since 1998, there is nonetheless higher infant mortality rates
in indigenous populations. This calls for improvements to the health system that will
provide better care to indigenous people.
Under-five mortality is the rate of mortality of children under 5 years of age.
• On an international scale, African nations see >200 deaths per 1000 births in 1990,
compared to Australia which had between 10-49 under 5 deaths per 1000 births.
• In 2011, the under 5 deaths in Africa decreased to 100-199 deaths per 1000, and
Australia had a decrease to >10 under 5 deaths per 1000 deaths.
Morbidity
Morbidity refers to be in a diseased state, disability, or poor health.
Co-morbidity refers to people who are experiencing multiple diseases in a given time.
DALY (disability adjusted life year): 1 DALY is 1 year of healthy life lost due to premature
death, prolonged illness/disability, or a combination of these factors. Disability refers to a
complication from a disease e.g. Diabetic patient having to have continual insulin injections.
It has nothing to do with functionally disabled people such as wheelchair etc.
DALY is used to measure the overall disease burden.
• DALY = years living with disease-disability + years of life lost
DALY is quite high in disadvantage populations such as those living in poverty or with low
socioeconomic status.
The Social Gradient
, The social gradient in health refers to the fact that inequalities in population health status
are related to inequalities in social status. i.e. health status is connected to social status.
Social status is related to:
• Education
• Income
• Employment status
• Area of residence
• Social connectedness
Socioeconomic status (SES) refers to the social and economic position of a given individual,
or group of individuals.
• It is usually, but not always, conceived as a relative concept and can be measured for
the individual, family, household or community
• In general, population areas of high socioeconomic status are seen as more well-off
than populations with low socioeconomic status
• Measures can be ambiguous and lead to ecological fallacy, whereby not all people in
high SES experience high SES, and not all people living in low SES areas experience
low SES living conditions.
Measures of Socioeconomic status
Socioeconomic status is generally unobserved, therefore proxy measures are used:
• Income
• Consumption
• Wealth
• Education
• Employment
However it is important to consider what is being used to measure SES, as measures can
change over time and within populations.
• E.g. Using TV as a measure or a telephone would not be relevant now, because in
today's age these things are seen more as a choice of the household, and not a
measure of health.
• Similarly, using broadband connection as a measure can be used to assess
socioeconomic advantage/disadvantage. However this measure would not be able to
be used in previous years.
Socioeconomic status and mortality
Why do we measure health?
There are many reasons to measure health, and this include:
1. Identify priority health issues that we should then allocate funding and resources.
This includes looking at the prevalence of a disease in population, and how it has
changed, and for different social/cultural groups.
Looking at the engagement of behaviours, e.g. Smoking, and if behaviours have
changed from policies. Determining if more funding needs to be allocated to a
particular disease, particular group, or behaviour.
2. Monitor progress - by using data to determine if health outcomes have improved or
worsened. To determine if differences in progress exist between different
groups/regions/cultures.
3. Re-evaluate health promotions - determine if government initiatives are improving
health of society. Evaluations are done before, during, and after implementing
health policies and behaviours. This provides more information about if a policy will
improve a particular health issue.
Health can be measured using epidemiology. Epidemiology is the study of patterns and
causes of health and disease in populations, and the application of this study to improve
health.
Decision making
The government in power at the time, develops programs on a local, national, and
international level, and also allocates funding to primary health care sectors (GP's),
secondary health care sectors (hospitals), and tertiary health care sectors (specialists).
Evaluation programs and determining their effectiveness helps governments make decisions
about funding.
• Following same group of people over time to see improvements in a program, e.g.
Measure up campaign
• Observing effect of an intervention, e.g. Trials of munch or move.
If policies and programs are effective, funding will continue to ensure that the services of a
policy/initiative continue to support the community.
If the policies/programs are not effective, governments can decide to remove funding, and
allocate it elsewhere.
Incidence and prevalence
,Incidence is the number of new cases of an illness/disease event at a given period of time. It
is used for more acute short term diseases such as COVID-19 or influenza.
• Incidence rate is the most precise measure which measures the rate at which new
cases occur
• Cumulative incidence is a measure of the occurrence of the disease within the
specified time.
Prevalence is the number of proportion of cases/instances in a population at a given time.
For example, in cancer, the prevalence refers to the number of people alive who have been
diagnosed with cancer in a certain period (1,5, 10 years). Prevalence is used to measure
disease that can last a long period of time.
• Point prevalence is prevalence that occurs at a specific point in time. E.g. Number of
vehicle accidents on the 31st December
• Period prevalence refers to prevalence in a certain period of time. E.g. Number of
vehicle accidents between January and December
Life expectancy
The number of years of life, on average, remaining to an individual at a particular age, if
death rates do not change.
The most common used measure is life expectancy at birth. It is expressed as the number of
years of life a person born today is expected to live.
In Australia, there has been a steady increase in the life expectancy between 1886-2016.
• In 2016, the life expectancy at birth was 80.4 years for males, and 84.6 years for
females.
• In this period, females have on average lived longer than males.
• Between 1956-1986 there was a larger gap between females and males life
expectancy. Possible reasons for this was World War 2. After 1986 this gap closed.
This type of data is useful in seeing trends. The increasing trend in life expectancy can be
attribute to medical advances such as medicine, surgery, and vaccination.
On an international level, Australia has quite a high life-expectancy. This has been seen since
1990, and has gradually increased life-expectancy since 1990, alongside Japan and Norway.
Other countries that have lower life-expectancy will have higher mortality rates.
Mortality
,Mortality refers to the number of deaths in a population, in a given period. Can be
measured for any population, national, social, or cultural level.
Pre-mature mortality is the potential years of life lost before the age of 70. In aboriginals,
the life expectancy is around 60, so they have higher rates of pre-mature mortality.
Infant mortality (IFR) is the number of deaths of children <1yo, per 1000 live births, in a
calendar year.
• There has been a significant decline in the number of infant mortalities between
1899-2009. Improvements in pre-natal care and maternal care have contributed to
this.
• In addition, the infant mortality rates in indigenous populations is higher. Although
their IFR has decreased since 1998, there is nonetheless higher infant mortality rates
in indigenous populations. This calls for improvements to the health system that will
provide better care to indigenous people.
Under-five mortality is the rate of mortality of children under 5 years of age.
• On an international scale, African nations see >200 deaths per 1000 births in 1990,
compared to Australia which had between 10-49 under 5 deaths per 1000 births.
• In 2011, the under 5 deaths in Africa decreased to 100-199 deaths per 1000, and
Australia had a decrease to >10 under 5 deaths per 1000 deaths.
Morbidity
Morbidity refers to be in a diseased state, disability, or poor health.
Co-morbidity refers to people who are experiencing multiple diseases in a given time.
DALY (disability adjusted life year): 1 DALY is 1 year of healthy life lost due to premature
death, prolonged illness/disability, or a combination of these factors. Disability refers to a
complication from a disease e.g. Diabetic patient having to have continual insulin injections.
It has nothing to do with functionally disabled people such as wheelchair etc.
DALY is used to measure the overall disease burden.
• DALY = years living with disease-disability + years of life lost
DALY is quite high in disadvantage populations such as those living in poverty or with low
socioeconomic status.
The Social Gradient
, The social gradient in health refers to the fact that inequalities in population health status
are related to inequalities in social status. i.e. health status is connected to social status.
Social status is related to:
• Education
• Income
• Employment status
• Area of residence
• Social connectedness
Socioeconomic status (SES) refers to the social and economic position of a given individual,
or group of individuals.
• It is usually, but not always, conceived as a relative concept and can be measured for
the individual, family, household or community
• In general, population areas of high socioeconomic status are seen as more well-off
than populations with low socioeconomic status
• Measures can be ambiguous and lead to ecological fallacy, whereby not all people in
high SES experience high SES, and not all people living in low SES areas experience
low SES living conditions.
Measures of Socioeconomic status
Socioeconomic status is generally unobserved, therefore proxy measures are used:
• Income
• Consumption
• Wealth
• Education
• Employment
However it is important to consider what is being used to measure SES, as measures can
change over time and within populations.
• E.g. Using TV as a measure or a telephone would not be relevant now, because in
today's age these things are seen more as a choice of the household, and not a
measure of health.
• Similarly, using broadband connection as a measure can be used to assess
socioeconomic advantage/disadvantage. However this measure would not be able to
be used in previous years.
Socioeconomic status and mortality
