Public Health Indicators Research Articles

Good health and well-being for the sustainable development of Moscow: state and prospects

Introduction. "Health and well-being of people" is the first national development goal of the Russian Federation until 2030. The Sustainable Development Goals (SDGs), also known as the Global Goals adopted by the United Nations (UN) in 2015, are comprehensive and indivisible and are being implemented everywhere [1].
 At the 2016 Shanghai Conference on Healthy Cities, people's health and well-being were placed at the center of the UN's 2030 Agenda for Sustainable Development (“Agenda 2030”). A preliminary assessment of the current state and current trends using the example of Moscow can be a “starting point” for making decisions in the field of public health management in large cities.
 Goal. To assess the progress of the city of Moscow towards achieving the third sustainable development goal (SDG 3).
 Materials and methods. For the analysis, data from open sources of the Federal State Statistics Service of Russia, the Rospotrebnadzor department for the city of Moscow were used.
 Results. Despite the pandemic, Moscow has maintained positive trends on a number of SDG targets and is advancing ahead (the proportion of births attended by skilled health workers; reducing infant and child mortality and tuberculosis incidence). There is also a decrease in mortality from traffic accidents, diseases of the circulatory system and neoplasms, primary incidence of malaria and hepatitis B. The assessment of public health indicators at the Moscow level is a new step in regional and territorial management through the use of the SDG 3 operational tool.

Monitoring of the population health and health risk factors (research methodology)

The article considers the dynamics of health indicators and health risk factors in Russia, including in comparison to the OECD countries. The study is based on the Russian statistical data, OECD data, and Russian Longitudinal Monitoring Survey (RLMS-HSE). The key public health indicator - the life expectancy (years of life at birth) - shows the negative dynamics in 2020 (71.54), while some other health indicators, on the contrary, show the positive dynamics, such as the self-rated health (the share of population aged 15+ in poor health deceased). 10.8 % of Russian adults consider themselves to be in poor health, which is higher than in the OECD countries. The share of people who assess their health as good and very good has increased over the 25 years of the study: the share of women has doubled (17.5 % in 1994 and 35.1 % in 2020); the share of men has increased by 13.2 % (34.4 % and 47.6 %). The share of people who drink alcohol and of men who smoke has decreased. However, there are negative trends that accompany risk factors: early initiation of smoking (8.5 % started smoking at 13 years and earlier, the majority (78.3 %) started smoking at puberty - at 18 and earlier; half of smokers smoke more than 15 cigarettes a day). The majority (66 %) of the RLMS participants at least occasionally drink alcoholic beverages, including beer (69.6 % of men and 55.3 % of women); never drink alcohol 34 % (30.4 % and 44.7 %). Every tenth respondent (11.9 %) tried an alcohol for the first time at the age of 14 or earlier; 77.9 % - at 18 and earlier. Over 25 years, the share of people with normal weight has decreased: 57.3 % of men and 43.4 % of women in 1994; 43.8 % and 40.5 % - in 2020. The share of overweight people has increased from 40 % of men and 51.9 % of women in 1994 to 53.5 % and 55.7 % in 2020.

Tracking changes in SARS-CoV-2 transmission with a novel outpatient sentinel surveillance system in Chicago, USA

Public health indicators typically used for COVID-19 surveillance can be biased or lag changing community transmission patterns. In this study, we investigate whether sentinel surveillance of recently symptomatic individuals receiving outpatient diagnostic testing for SARS-CoV-2 could accurately assess the instantaneous reproductive number R(t) and provide early warning of changes in transmission. We use data from community-based diagnostic testing sites in the United States city of Chicago. Patients tested at community-based diagnostic testing sites between September 2020 and June 2021, and reporting symptom onset within four days preceding their test, formed the sentinel population. R(t) calculated from sentinel cases agreed well with R(t) from other indicators. Retrospectively, trends in sentinel cases did not precede trends in COVID-19 hospital admissions by any identifiable lead time. In deployment, sentinel surveillance held an operational recency advantage of nine days over hospital admissions. The promising performance of opportunistic sentinel surveillance suggests that deliberately designed outpatient sentinel surveillance would provide robust early warning of increasing transmission.

Understanding and addressing COVID-19 vaccine hesitancy in low and middle income countries and in people with severe mental illness: Overview and recommendations for Latin America and the Caribbean.

Despite the speedy development of vaccines for COVID-19, their rollout has posed a major public health challenge, as vaccine hesitancy (VH) and refusal are high. Addressing vaccine hesitancy is a multifactorial and context-dependent challenge. This perspective focuses on VH in the world region of Latin America and the Caribbean (LAC) and includes people suffering from severe mental illness, therefore covering populations and subpopulations often neglected in scientific literature. We present an overview of VH in LAC countries, discussing its global and historical context. Vaccine uptake has shown to widely vary across different subregions of LAC. Current data points to a possible correlation between societal polarization and vaccination, especially in countries going through political crises such as Brazil, Colombia, and Venezuela. Poor accessibility remains an additional important factor decreasing vaccination rollout in LAC countries and even further, in the whole Global South. Regarding patients with severe mental illness in LAC, and worldwide, it is paramount to include them in priority groups for immunization and monitor their vaccination coverage through public health indicators.

Wild type and variants of SARS-COV-2 in Parisian sewage: presence in raw water and through processes in wastewater treatment plants.

The presence of SARS-CoV-2 RNA has been extensively reported at the influent of wastewater treatment plants (WWTPs) worldwide, and its monitoring has been proposed as a potential surveillance tool to early alert of epidemic outbreaks. However, the fate of the SARS-CoV-2 RNA in the treatment process of WWTP has not been widely studied yet; therefore, in this study, we aimed to evaluate the efficiency of treatment processes in reducing SARS-CoV-2 RNA levels in wastewater. The treatment process of three WWTPs of the Parisian area in France was monitored on six different weeks over a period of 2 months (from April 14 to June 9, 2021). SARS-CoV-2 RNA copies were detected using digital polymerase chain reaction (dPCR). Investigation on the presence of variants of concern (Del69-70, E484K, and L452R) was also performed. Additionally, SARS-CoV-2 RNA loads in the WWTPs influents were expressed as the viral concentration in per population equivalent (PE) and showed a good correlation with French public health indicators (incidence rate). SARS-CoV-2 RNA loads were notably reduced along the water treatment lines of the three WWTPs studied (2.5–3.4 log reduction). Finally, very low SARS-CoV-2 RNA loads were detected in effluents (non-detected in over half of the samples) which indicated that the potential risk of the release of wastewater effluents to the environment is probably insignificant, in the case of WWTPs enabling an efficient biological removal of nitrogen.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11356-022-22665-x.

The Impact of the COVID-19 Pandemic on Inpatient Admissions for Psychotic and Affective Disorders: The Experience of a Large Psychiatric Teaching Hospital in Romania.

The COVID-19 pandemic resulted in a global sanitary crisis and, in addition, elicited serious mental health consequences. The utilization of psychiatric hospital-based services acts as an indicator of public mental health. Therefore, this research sought to investigate differences in the numbers and characteristics of inpatient admissions for psychotic and affective disorders at the largest Romanian psychiatric hospital between the period of lockdown (16 March–15 May 2020) and another three corresponding periods: the same year in the pre-lockdown period (16 January–15 March 2020), the immediate post-lockdown period (16 May–15 July 2020), and two years later (16 March–15 May 2022). A retrospective analysis was performed. The study included a total of 6604 patients. Inpatient admissions decreased during lockdown in comparison with the pre-lockdown period and immediate post-lockdown period for psychotic disorders (p < 0.001 and p < 0.001, respectively) and affective disorders (p < 0.001 and p < 0.001, respectively). For both psychotic and affective disorders, a decrease in the age of the patients admitted during lockdown, as compared with the pre-lockdown period (p < 0.05 and p < 0.001, respectively), was observed. The length of the hospital stay for affective disorders was higher immediately post-lockdown in comparison with the lockdown period (p < 0.001). Collectively, the present findings provide a glimpse of the immediate and long-term consequences of the COVID-19 pandemic and lockdown measures on patients’ access to mental healthcare in the form of hospitalization, and these findings could provide the basis for the development of a different approach to times of crisis.

Classification of Deprivation Indices That Applied to Detect Health Inequality: A Scoping Review.

Introduction: Many studies around the world are undertaken to establish the association between deprivation and public health indicators. Both separate indicators (e.g., income, education, occupation, public security and social support) and complex models (indices) include several indicators. Deprivation indices are actively used in public health since the mid 1980s. There is currently no clear classification of indices. Methods: In the current review, data related to deprivation indices are combined and analyzed in order to create a taxonomy of indices based on the results obtained. The search was carried out using two bibliographic databases. After conducting a full-text review of the articles and searching and adding relevant articles from the bibliography, and articles that were already known to the authors, sixty studies describing the use of sixty deprivation indices in seventeen countries were included in the narrative synthesis, resulting in development of a taxonomy of indices. When creating the taxonomy, an integrative approach was used that allows integrating new classes and sub-classes in the event that new information appears. Results: In the review, 68% (41/60) of indices were classified as socio-economic, 7% (4/60) of indices as material deprivation, 5% (3/60) of indices as environmental deprivation and 20% (12/60) as multidimensional indices. Conclusions: The data stimulates the use of a competent approach, and will help researchers and public health specialist in resolving conflicts or inconsistencies that arise during the construction and use of indices.

“We cobble together a storyline of system performance using a diversity of things”: a qualitative study of perspectives on public health performance measurement in Canada

BackgroundThere have been longstanding calls for public health systems transformations in many countries, including Canada. Core to these calls has been strengthening performance measurement. While advancements have been made in performance measurement for certain sectors of the health care system (primarily focused on acute and primary health care), effective use of indicators for measuring public health systems performance are lacking. This study describes the current state, anticipated challenges, and future directions in the development and implementation of a public health performance measurement system for Canada.MethodsWe conducted a qualitative study using semi-structured interviews with public health leaders (n = 9) between July and August 2021. Public health leaders included researchers, government staff, and former medical officers of health who were purposively selected due to their expertise and experience with performance measurement with relevance to public health systems in Canada. Thematic analysis included both a deductive approach for themes consistent with the conceptual framework and an inductive approach to allow new themes to emerge from the data.ResultsConceptual, methodological, contextual, and infrastructure challenges were highlighted by participants in designing a performance measurement system for public health. Specifically, six major themes evolved that encompass 1) the mission and purpose of public health systems, including challenges inherent in measuring the functions and services of public health; 2) the macro context, including the impacts of chronic underinvestment and one-time funding injections on the ability to sustain a measurement system; 3) the organizational structure/governance of public health systems including multiple forms across Canada and underdevelopment of information technology systems; 4) accountability approaches to performance measurement and management; and 5) timing and unobservability in public health indicators. These challenges require dedicated investment, strong leadership, and political will from the federal and provincial/territorial governments.ConclusionUnprecedented attention on public health due to the coronavirus disease 2019 pandemic has highlighted opportunities for system improvements, such as addressing the lack of a performance measurement system. This study provides actionable knowledge on conceptual, methodological, contextual, and infrastructure challenges needed to design and build a pan-Canadian performance measurement system for public health.

Regional green economy and community impact on global sustainability

PurposeThis study aims to explore the impact of regional green economies and communities on global sustainability. This study attempts to show if the empirical results align with the regional sustainable development policy and practices.Design/methodology/approachEmpirical analyses are conducted through time-varying correlations, structural break tests and volatility modeling. As a public health indicator, the community variable is proxied by the daily COVID-19 cases.FindingsAccording to the results, the US green economy and global sustainability relationship exhibit a greater variety than that of Europe and Asia regions. Volatility modeling reveals that green economies are significant variables for each region in accounting for the changes in global sustainability. Europe and Asia have the highest and lowest effects in this interaction, respectively. The results are consistent with the carbon emission statistics of the regions studied and the government’s efforts to promote sustainable development. Furthermore, this study supports the efforts of the European Union to tackle climate and environmental issues, as well as create a resource-efficient economy and truly prosperous society.Originality/valueThis study presents empirical findings concerning global sustainability by providing evidence from three regions. The outcomes on the extent of regional contribution to global sustainability may lead the policymakers to develop new strategies in the management of turmoil periods such as a pandemic.

К вопросу о современном состоянии медико-демографической ситуации в России

At the present stage in Russia, the main strategic initiatives aimed at improving medical and demographic processes are set out in a number of regulatory documents presented in the form of national projects, concepts, strategies and other federal projects, while special attention is required to study and monitor these indicators of public health of the population. Purpose of the study is analysis of the medical and demographic situation in Russia and in individual subjects in recent years, making proposals to improve the processes of fertility and mortality, migration growth. Materials and methods. Scientific publications, official statistical data and analytical materials of Rosstat, data from the statistical collection of the SFO were used as research materials. Statistical data processing was carried out using SPSS, Excel‑2007 packages. The main research methods were: the study and generalization of experience, information-analytical, statistical, bibliographic. Results. The analysis of the dynamics of indicators of the demographic situation in the Russian Federation determined a low degree of compliance with the priorities of the state policy; there was a negative dynamics and a discrepancy between the actual value of the planned target indicators, therefore, in order to eliminate the existing problems, it is necessary to take into account the specifics of individual territories when setting and formulating strategic directions and initiatives on this problem. Findings. The results of the study indicate the need for constant monitoring of the main demographic indicators, considering certain directions and the course of the state policy pursued in this direction.

Impact of Economic Freedom and Educational Attainment on Life Expectancy: Evidence From the New EU Member States.

Life expectancy is a significant indicator of public health, life quality, welfare and economic development. Therefore, improvement in life expectancy is among the priority targets of the countries. This paper investigates the effect of economic freedom and educational attainment on life expectancy in the new EU member states, experiencing an institutional, educational, and economic transformation, during the period 2000–2019 by using cointegration and causality tests, because economic freedom and educational attainment can foster the life expectancy through institutional and economic variables such as institutions, governance, sound monetary and fiscal policies, economic growth, innovation, technological development, better living standards and access to superior healthcare services. The causality and cointegration analyses reveal that economic freedom and educational attainment are significant factors underlying life expectancy in the short and long term. However, educational attainment is found to be more effective on life expectancy than economic freedom. The findings have important implications for educational and health policies in analyzed countries. Governments must understand the education–health relationship to be able to develop and promote educational policies that have the potential to improve public health.

Indicators of Intellectual Thinking as Healthy Thinking and Its Relation with Health-Promoting Lifestyle: A New Perspective in Clinical Psychology and Public Health.

Quality of life is determined by the lifestyle of individuals. If people have a healthy lifestyle, then they have a higher quality of life. What makes a person's lifestyle is the way he thinks. Therefore, if the thinking is healthy, the person's lifestyle will be healthy, and if the thinking is unhealthy, the person's lifestyle will also be damaged, which will reduce the quality of life. The research method was mixed method in two quantitative and qualitative phases. The research method in the qualitative phase was customary qualitative content analysis, in which the data analysis process was based on the approach of Granheim and Ladman. In the quantitative phase, the psychometric properties of the research scale were measured. This research was conducted from 2016 to 2021 in Iran. The statistical population in the qualitative section was all scientific texts in the form of articles, books and dissertations that were extracted from scientific databases such as ScienceDirect, PubMed, Elsevier, Ebsco, Sid, Magiran. Indicators of intellectual thinking have been mentioned as research results, which are the main components of the new model of thinking. Moreover, the level of thinking was mentioned and Cognitive distortions, cognitive bias, and perceptual errors were mentioned as sources of harm and error. Intellectual thinking has been mentioned as healthy thinking, which is the main factor of a health promotion lifestyle because healthy lifestyle improves the quality of life of people, which is one of the indicators of public health. Therefore, a higher quality of life can be achieved from the model of healthy thinking, which is a new perspective on promoting public health.

Epidemiology of stillbirths based on different gestational thresholds at a tertiary hospital.

The stillbirth rate (SBR) is an important public health indicator. We studied the distribution of maternal and fetal characteristics and time trends of the SBR at KK Women's and Children's Hospital (KKH), Singapore, from 2004 to 2016 based on various definitions of stillbirth. Data was obtained from the Data Warehouse and Stillbirth Reporting System of KKH from 2004 to 2016. SBRs were calculated based on three definitions (fetal deaths at ≥ 20 weeks, 24 weeks or 28 weeks of gestation per 1,000 total births) and were described with maternal and fetal characteristics, and by year. From 2004 to 2016, the SBR declined by 44.7%, 25.5% and 18.9% based on Definitions I, II and III, respectively. The SBR at KKH in 2016 was 5.2 (Definition I), 4.1 (Definition II) and 3.0 (Definition III) per 1,000 total births. The SBR was significantly higher in women aged ≥ 35 years, nulliparas and female fetuses. The number of live births at 24-27+6 weeks of gestation was more than four times higher than that of stillbirths (822 vs. 176). There were 104 (12.7%) neonatal deaths during this gestation period, giving a high survival rate of 87.3%. The SBR in KKH is relatively lower than that in other developed countries. There is a need to consider revising our hospital and national definitions of the stillbirth lower boundary from 28 weeks to 24 weeks of gestation. This would allow us to make better comparisons with other developed countries, in line with improvements in healthcare.

PEMODELAN MIXED GEOGRAPHICALLY WEIGHTED REGRESSION DENGAN ADAPTIVE BANDWIDTH UNTUK ANGKA HARAPAN HIDUP (Studi Kasus : Angka Harapan Hidup di Jawa Tengah)

Life expectancy at birth (AHH) is an estimate of the years a person will take from birth. AHH is used as an indicator of public health and welfare. These two indicators are of concern to the government in relation to human development. It is hoped that the AHH value will continue to increase so that the quality of human development will also increase. Modeling of the factors that influence AHH needs to be done so that efforts to increase AHH become more effective.The AHH value for Central Java (Central Java) in 2020 is 74.37. Factors thought to influence AHH in Central Java are the percentage of poor people (X1), the percentage of households with proper sanitation (X2), the percentage of children under five who are fully immunized (X3) and the open unemployment rate (X4). The assumption of homoscedasticity in AHH modeling in Central Java using linear regression was not fulfilled, meaning that there was spatial heterogeneity between districts/cities, so the Geographically Weighted Regression (GWR) method was used. The weighting function used is the Bisquare and Tricube kernels with adaptive bandwidth. The GWR method will encounter problems if not all independent variables are local, so the Mixed Geographically Weighted Regression (MGWR) method is used. The results of the GWR analysis for the two weighting functions are that the X1 variable is not local, so the MGWR method is used. The results of MGWR modeling for the two weighting functions are that local variables and global variables have a significant effect. The best model is the MGWR model with Kernel Tricube weighting because it has the smallest AICc value. Keyword : AHH, GWR, MGWR, Adaptive Kernel Bisquare, Adaptive Kernel Tricube, AICc

Subjective dignity and self-reported health: Results from the United States before and during the Covid-19 pandemic

AimsTo describe disparities in depressive symptoms and self-rated health with a novel, individual-level measure of subjective dignity administered before and during the COVID-19 pandemic. MethodsNational survey data were collected across the United States by the Gallup Organization in Spring (2017) (n ​= ​1459) and again in Spring (2021) (n ​= ​1244). Subjective dignity is measured by self-reported perceptions of dignity in one’s own life. Numerous demographic subgroups constructed across age, gender, race/ethnicity, education, income, urbanicity, labor force status, and political background are used to test for robustness of dignity-health associations within and across years. ResultsAll demographic subgroups studied reported numeric decreases in dignity from 2017 to 2021, with many of these decreases being both large and significant. With few group-year exceptions, subjective dignity relates to lower levels of depression and higher self-rated health, with dignity-depression associations significantly increasing from 2017 to 2021. ConclusionsDignity, as a pluralistic moral concept, is purported to anchor legal, human rights, and cultural discourses on justice, equity, and social inclusion. This study provides timely, original evidence that subjective appraisals of dignity should be considered as a public health indicator, especially across periods of societal unrest or adversity. Given groupwise robustness of dignity-health associations as documented here, subgroup determinants and lay definitions of dignity may merit closer attention.

Comparative analysis of the infant mortality rate in the Russian Federation and the Privolzhsky Federal District over 1999–2018

Introduction. The infant mortality (IM) rate is a serious medical, social and demographic problem. This is one of the main indicators of public health, which characterizes not only the quality of the medical and preventive care for women and children, but also the level of socio and economic well-being. The purpose of the study was to investigate the trend in IM indicators in the Privolzhsky Federal District (PFD) and the Russian Federation (RF) over a twenty-year period (1999-2018) and to determine the relationship with the indicators of gross domestic product (GDP). Material and methods. The analysis of official statistical data is carried out and the comparison of regional indicators with the national average values and data for a number of countries of the world is carried out. The paper uses statistical and analytical methods. The correlation between IM, total mortality and the gross regional product (GRP) per capita in the Privolzhsky Federal District and GDP per capita in the Russian Federation is carried out. Results. Over the past 20 years, both in the Privolzhsky Federal District and in the Russian Federation, a decrease in the IM rate value was found to be registered by more than 3 times. There is a strong negative relationship between IM rate and GRP per capita in the Privolzhsky Federal District and IM rate and GDP per capita in the Russian Federation. Limitations. The analysis of infant mortality in the territory of the Privolzhsky Federal District and in the Russian Federation for a 20 years was carried out using a continuous method according to official statistical reports, which is a sufficient reference sample. Conclusion. Without reducing the IM rate in all subjects and districts of the Russian Federation, it is impossible to achieve its reduction in the country as a whole. The main tool for achieving this goal is the implementation of the National Project “Health Care”, which provides, among other things, the reduction of IM. At the same time, IM indicator in Russian Federation was already less than the indicator value of 2020 in 2018, and its value in the Privolzhsky Federal District reached the planned level of 2022. Thus, the final indicator of the National Project is not only achievable, but can also be adjusted in the process of its implementation.

Preterm delivery rate in China: a systematic review and meta-analysis

BackgroundPreterm delivery rate is a crucial public health indicator, yet reliable statistic is currently not available in China. In this systematic review and meta-analysis, we aimed to review studies on preterm delivery rate in China, explore sources of heterogeneity, and estimate the preterm delivery rate in China.MethodsPublished studies on preterm delivery rate in China since 2010 were electronically searched from PubMed, Embase, Web of Science, China National Knowledge Infrastructure, China Science and Technology Journal Database, and Wanfang Database, and complemented by manual search. Study selection, data extraction, and quality and bias assessment (using the Joanna Briggs Institute Critical Appraisal Checklist) were conducted by two reviewers independently. Random-effects meta-analysis was performed to estimate the pooled preterm delivery rate, and prespecified stratified analysis was conducted to explore sources of heterogeneity.ResultsThe database search returned 4494 articles and manual search identified 10 additional studies. In total, 162 studies were eligible, of which 124 were hospital-based and 38 population-based. The pooled preterm delivery rate of hospital-based studies (7.2%; 95% CI: 6.9% to 7.6%) was significantly higher than that of population-based studies (4.9%; 95% CI: 4.5% to 5.4%) (P for subgroup difference < 0.001). Among population-based studies, the rate tended to differ by geography (P for subgroup difference = 0.07): 5.3% for Eastern, 4.6% for Central, and 3.8% for Western.ConclusionsAccording to population-based studies, the preterm delivery rate in China is around 5%. This rate is substantially lower than estimates from hospital-based studies or estimates from a combination of both hospital-based and population-based studies as having been done in previous studies.

Real-world visual outcomes of cataract surgery based on population-based studies: a systematic review

Background/aimsQuantity of cataract surgery has long been an important public health indicator to assess health accessibility, however the quality of care has been less investigated. We aimed to summarise the...

Fiscal, Economic, Health and Cultural Indicators Connected with the Development of Sport

In the last century, sport has gradually shifted from a leisure activity to an economic sector. The implications are numerous, the relations with the economic and social life have developed enormously. The commercial relations that appeared around the sports activities led to the consolidation of some financial flows in relation to the sports equipment manufacturers, the governmental authorities, the written and audio-visual press. Our study assesses the relationship between the level of development of sport at national level and several economic, fiscal, cultural, and public health indicators for European countries. The data required for the estimates are collected from international institutions such as Eurostat, World Bank, World Health Organization, Global Association of International Sports Federations, and national sports institutions from the sampled countries. Bivariate analysis shows more or less strong correlations with the socio-economic indicators considered. However, these results can be altered by possible situations of multicollinearity that can cause confusion. In the multivariate analysis, hierarchical clustering indicates five behavioural types of countries in terms of the relationship between public and professional sport with macroeconomic aggregates.

Ranking Universities of Medical Sciences as Public Health Services Provider Institutions in Iran: A Result-Chain Analysis.

Universities of medical sciences (UMSs) in Iran have geographic catchment areas (normally a province) in which they are responsible for public health services as well as provision of care by public providers. The present study strived to analyze and rank the performance of the medical sciences universities in improving the public health and primary healthcare. Data on 41 indicators on the output (16 indicators), outcome (16 indicators), and impact (9 indicators) levels were extracted from various data sources. Principal component analysis (PCA) was used to calculate the weight for each of the indicators. The score range for each level of performance is between 0 and 1. A score of 1 indicates the highest and a score of 0 indicates the lowest level of performance. Finally, the UMSs were ranked by their scores. The national mean performance scores of the UMSs on the output, outcome, impact, and the composite indicator levels were 0.756, 0.641, 0.561, and 0.563, respectively. The results show that the changes in performance scores at different levels of the results chain are remarkable. The national mean performance of the UMSs of Iran is not satisfactory. However, there is considerable dispersion in their performance. Designing effective interventions in proportion to the conditions of universities on different levels of the results chain, developing a robust information system, conducting continuous monitoring and evaluation of public health are recommended for balanced improvements in public health and primary healthcare indicators in the country.