Global Health problem

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Chapter Two

Health Determinants, Measurements, and Trends

Overview

What are the determinants of health?

What are the most important health indicators and key terms related to measuring health status and the burden of disease?

What are the leading causes of death and the burden of disease in low-, middle-, and high-income countries?

What are the demographic and epidemiological transitions?

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 in health status that have occurred historically

Determinants of Health

The interconnected factors that determine an individual’s health status

Determinants include personal and inborn features, socioeconomic 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

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

Carrying out disease surveillance

To perform these functions, it is important to use a consistent set of indicators in order to make comparisons

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

Key Health Indicators

Terms

Prevalence—number of people suffering from a certain health condition over a specified period

Incidence—the rate at which new cases of a disease occur in a population

Key Health Indicators

Communicable diseases—illnesses caused by a particular infectious agent that spreads directly or indirectly from people to people, animals to people, or people to animals; also called infectious diseases

Noncommunicable diseases—illnesses not spread by an infectious agent

Injuries—include road traffic injuries, falls, self-inflicted injuries, and violence, among other things

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

Often there are cultural barriers to timely vital registration

Vital Registration

Measuring the Burden of Disease

Health-Adjusted Life Expectancy (HALE)

Summarizes expected number of years to be lived in what might be termed the equivalent of good health

A health-expectancy measure

To calculate HALE: the years of ill health are weighted according to severity and subtracted from overall life expectancy

Measuring the Burden of Disease

Disability-Adjusted Life Year (DALY)

The sum of years lost due to premature death (YLLs) and years lived with disability (YLDs). DALYs are also defined as years of healthy life lost

A health-gap measure

Indicates losses due to illness, disability and premature death in a population

Burden of Disease Data

Important to gain an understanding of:

Leading causes of illness, disability, and death in the world

Variations in these causes by age, sex, ethnicity, and socioeconomic status

Changes over time and how these causes might change in the future

Burden of Disease Data

Overview of Patterns and Trends in the Burden of Disease

People in much of the world are living longer than before and dying at lower rates than earlier

As people live longer, there is an increase in the years people live with disability

The burden of disease is predominantly noncommunicable in all World Bank regions, except sub-Saharan Africa

Burden of Disease Data

Overview of Patterns and Trends in the Burden of Disease

Over the last few decades, the burden of disease has shifted increasingly toward noncommunicable diseases in all World Bank regions

This shift has been fueled, among other things, by a reduction in communicable diseases and the aging of populations

Burden of Disease Data

Causes of Death by Region

Higher income countries tend to have a greater burden of noncommunicable diseases

The lowest income countries have a greater burden of communicable diseases

Africa and South Asia are set apart by their large burdens of communicable disease

Burden of Disease Data

The Burden of Deaths and Disease Within Low- and Middle-Income Countries

Rural people will be less healthy

Disadvantaged ethnic minorities will be less healthy

Females will suffer from their weak social positions

Poor people will be less healthy

Uneducated people will be less healthy

Risk Factors

Risk factor—an aspect or personal behavior or lifestyle, 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

Risk Factors

Demography and Health

Population Growth

Current world population is 7.2 billion and growing

Majority of population growth will occur in low- and middle-income countries

This growth will put substantial pressure on the environment and infrastructure

Demography and Health

Population Aging

Population of the world is aging

Elderly support ratio—ratio between the number of people that are 15–64 years of age, compared with the number that are 65 years of age or older

Affects burden of disease because people will be living longer with morbidities and disabilities

Affects healthcare financing because of costs of caring for older people

Demography and Health

Urbanization

In the last decade, most of the world’s population has lived their entire life in urban areas

People are continuing to move from rural to urban areas, especially in low- and middle-income countries

There is enormous population pressure on urban infrastructure, such as water and sanitation

Demography and Health

The Demographic Divide

Highest income countries: low fertility, often declining populations, aging populations

Lowest income countries: relatively high fertility, growing populations

Demography and Health

The Demographic Transition

Shift from pattern of high fertility and high mortality to low fertility and low mortality

Mortality declines with better hygiene and nutrition

Population grows with gap between births and deaths

Fertility declines

Population growth slows and older share of population increases as births and deaths equalize

Demography and Health

The Epidemiologic Transition

Shift from burden of disease dominated by communicable disease to burden of disease dominated by noncommunicable disease

Low-income countries are going through it now

First, and historically: high and fluctuating mortality, related to very poor health conditions, epidemics, and famine

Demography and Health

The Epidemiologic Transition

Then, progressive declines in mortality as epidemics become less frequent

Finally, further declines in mortality, increases in life expectancy, and the predominance of noncommunicable diseases

The pace of this transition depends on factors related to the determinants of health

Demography and Health

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 lags behind other regions

Life expectancy in Europe and Central Asia changed little from 1990-2011, related to break-up of Soviet Union

Life expectancy in East Asia increased dramatically, partly due to rapid economic growth

Progress in Health Status