The measurement of levels of health

Abstract

The measurement of health Why has so little been said about the measurement of levels of health in scientific gatherings on tropical medicine and hygiene? Is health perhaps a “disembodied concept which stimulates no emotional response” ( Dubos, 1965) . Health is a value embedded in a highly complex network of norms and attitudes of a given society and health is also dependent upon the interaction between the bio-physical environment and socio-economic development. So concepts about health may differ from a near total acceptance of disease and death as an inevitable natural phenomenon towards a continuous search for new ways of well-being. This may, at least partly, explain the reluctance to collect, analyse and compare different vital and health statistics on an international level, and the difficulty to develop new parameters for measuring levels of health. The scientific value of internationally available statistics about mortality, morbidity and other health parameters especially from developing countries is usually doubted. To challenge this assumption some 65 different health data and health-influencing factors were collected from official sources for 103 countries, developed as well as developing ones. 29 doctors, participating in the International Course in Health Development 1970–1971, volunteered in this study. Many difficulties were encountered. It often occurred that data either were not available or were probably not in accordance with reality. In that case estimates or even “guestimates” had to be made. In spite of these limitations an attempt was made to discover general patterns in the levels of health of the various countries, when grouped into larger regions. These regions were the Americas, Europe, Africa and Asia, including countries and territories in the Pacific. The crude death rate was shown to be a good health indicator for all the developing countries (notably in Africa), where the death rates, originally high, are decreasing. This indicator, however, completely looses its significance, when it starts to increase again as the result of the ageing of the population. The infant mortality rate was as expected lowest in Europe and highest in Africa with intermediate levels for Asia and the Americas. Childhood (1–4 years of age) mortality, however, showed a different pattern. This rate was lowest again in Europe, intermediate for the Americas but generally very high, both for Africa and Asia. This would indicate that the risks to life in Asia are intermediate for infants but still considerable for the preschool child. In general the value of the various health parameters as indicators is very much dependent on the general level of development. The various health indicators are also influenced by bio-physical and socio-economic factors. Childhood mortality for instance appeared to be mostly correlated with per caput income and consumption of animal protein, annual increase of population and the incidence of infectious and parasitic diseases. Correlations and intercorrelations according to regions are being analysed. On this basis it seems possible to indicate to what extent the various health indicators are related to natural and man-made factors in the different phases of development. This would lead us to the possibility of health planning on a quantified statistical basis through pilot research projects for later implementation on a national, regional and international level.