When we walk into a doctor's office, the first thing they do is take our blood pressure or temperature. Why do they do that? Well, I think most of us probably know that what they're really looking for is good indications of what's going on in our bodies and whether or not we're in some kind of urgent situation. So if you're concerned about the health of a community, what would you measure? In this module, we're going to describe the types of population health indicators that are used by the World Health Organization. So this organization is put together a population health indicators that would allow people from many different countries to compare where they are and actually they form a pretty core set of indicators that most of us should be paying attention to, if we think about population health. We're also going to describe the uses of those population health indicators, because while they might present a single measurement that can be used in many different ways. And then last, we're going to dig into those World Health Organization's 100 core health indicators. So what is a population health indicator? in many ways, it's any kind of measure that's reflecting the health of people in your community and we'll go over some standard ones, but people create them all the time. And if they are good fits for your community, you should use them. The basic types of population health indicators are health status indicators, health determine and indicators and then health system indicators. Each one is measuring something slightly different about the population health. The health status indicators make a lot of sense. You probably already know many of them. Life expectancies, mortality like infant mortality, chronic disease rates, things that are really representing how well are people doing in terms of their actual health outcomes. But the health determined indicators, these fall underneath of the framework that we've talked about in terms of social and environmental as well as individual behaviors that are risk factors for disease. So it can be things like income or nutrition. Think about water quality or air quality, or people's behaviors like smoking, or alcohol. And then there's health system indicators, because we do know the population health is related to our health system in our healthcare. So these are trying to measure aspects of the healthcare quality that people are getting, as well as their access. What is financing them is our country spending enough or they not spending where they should and then utilization are people using the healthcare services that are there, and what are the outcomes if they do? These are the big types of population health indicators that most people focus on. So who creates these population health indicators? Well, there's a fair amount of emphasis by global agencies like the World Health Organization or the Organization for Economic Cooperation and Development. They are invested in creating really good population health indicators that can be used across many countries at many different resource levels in order for us to have a better sort of global or worldwide perspective on what's happening in populations. There's also a number of population health indicators that are made more locally. So at the federal state and local level. These are ones that are more, call it prioritized to being able to track funding and its impact. So we put a fair amount of emphasis on prevention programs and intervention programs, and how are they doing is really assess by looking at changes in population health indicators that have been developed. And then of course, there's a whole bunch of people working in population health in the civil sector. So the non-government organizations, community organizations, philanthropic organizations and foundations, universities, businesses. So they also are developing population health indicators that sometimes go to the metrics of the goals that they are trying to achieve. So many different people can make population health indicators. How are they used? Well, they're used in many different ways. The sort of obvious one is to monitor what is happening at the population level in terms of the health, the health determinants and then the healthcare systems. But they also form a way to communicate critical information quickly and to people in many different sectors. A lot of times, they're used as a motivation to get funding or to gather resources when you see that there's a population health indicator that is showing a critical need that usually is what is the motivator to actually get resources for change. It also is a great way if they stay stable to track progress, to track and evaluate whether or not the intervention really made a difference. When we think about both using these population health indicators to motivate change, you also can imagine that it's used to promote accountability. So if somebody says they made a change or they're working on it, did it really happen? And especially for governments that are I'm going to say, constantly trying to negotiate very complex uses of tax dollars. Promoting accountability through population health indicators can be one of the ways in which sort of people and government agencies are in constant dialogue. It's also a sort of surefire way to figure out what things need the most attention sort of now or have the highest priority. Because if the population health indicator says that you're doing well or at least average, then that's probably not going to get as much of your attention as those population health indicators that says, your critically at the lower part of the distribution. You are not achieving population health in this domain. So identifying priorities is another key way in which we use it. And then last, the ability to encourage action and collaboration not necessarily by agencies and organizations put by the general population the community the people that actually need to engage in different behaviors or screenings or things like that. Sometimes people seeing, wait a second. Our community really isn't doing well here. I'm going to do my part. So for the rest of this module, we're going to focus and on the global reference list of the hundred core health indicators that was developed by the World Health Organization. These are health indicators that have been prioritized by the global health community. So it's not just the organization, but many different countries are represented in terms of their desire to have these health indicators measured not only inside of their country, but across. They really are great at providing concise information about what is happening sort of the situation and trends inside of countries and they also assist in helping to track people's responses to different emerging infections or to sort of even disasters that have been kind of experience by different countries, or counties. They fall into four different groups. So there's health status indicators, risk factors, health service coverage indicators and health system indicators. All of them are widely available and people use them a fair amount to compare across jurisdictions. Not only kind of locally with some within their region, but then across different regions of the world. The first is a health system indicators. Here we have a set of indicators that are looking at mortality by age and sex, some of the most vulnerable like children and infants as well as sort of an overall indicator of life expectancy, then there's mortality by cause. So these are the big causes. Age, TB, causes from environmental and social factors. Fertility, simple fertility rates, but then also rates of adolescent birth rates morbidity morbidity due to vaccine preventable diseases HIV hepatitis as well as killers like cancer. Next are the health determinant indicators. So these are the risk factors. Risk factors like nutrition, infections. Environmental risk factors like is there safely manage drinking water and sanitation, non-communicable diseases. Things that have much more to do with individual level behaviors, physical activity. Tobacco whether or not somebody is overweight or obese, salt intake. And then lastly, injuries and harmful traditional practices like female genital mutilation, intimate partner violence, early marriage as well as occupational injuries. The next set of health indicators have to do with health service coverage and this is really divided into a large number of categories ranging from reproductive, maternal newborn and child and adolescent coverage, coverage of immunization, HIV, tuberculosis, malaria. Tropical diseases that are often neglected as well as things like screening and preventative care, mental health, substance abuse and then essential health services. I won't go into all of them, but just knowing that health service coverage is a major part of the World Health Organization's view of what really should be call it a standard for health across the world is an important contributor actually to some of the successes and population health that we've seen. Lastly are the health system indicators. So these are really indicators of how well the health system is achieving its goal. So their issues that are being monitored like quality and safety of care, utilization and access. Whether or not there is not healthcare professionals in the health workforce, or if health information is being stored like birth and death and whether, or not there's enough support for reporting by facilities. And then the health financing, health security and then health governance is their existence of a national health sector policy, a strategy a plan, because not all countries have them and the United States. We have a fair amount of data that we can use for the WHO, as well as other population health indicators. Here are just a few of the sources. So for health data, we might go to National Vital Statistics systems disease surveillance systems. There are some surveys that are rolled out on a regular basis like the National Survey of Child Health. And then of course, there's administrative data that has good information on health outcomes for the country from Medicare, Medicaid, hospital billing data. Those are all great sources for health outcomes. To get at the health determinants as another set of surveys as well as data from other agencies, the behavioral risk factor surveillance survey is really, probably the best known for health determinants. But the census also does an American community survey of hundreds of thousands of people every year that has a really rich set of data on social and environmental factors. Of course, education data. We could get from education agencies. There's also environmental data, air quality, water quality, toxin release data from the EPA, the Environmental Protection Agency and then there's a fair amount of information that is tucked within human services, justice system administrative data. That is more around incarceration or homelessness, or other kind of indicators of very severe health determinants. The last area of the health system indicators. Well, you can get some of it from patient experience surveys. But a lot of it is coming from national surveys like the medical expenditure, panel survey, billing for hospitalizations, federal claims data and then the National Committee for Quality Assurance created a set of measures, these HDS measures that most healthcare systems are using as indicators of just how well they're doing. Well, we've talked a fair amount about sort of single statistics on mortality and morbidity being good population health indicators. There's also been a development of composite measures. So this is taking multiple statistics and making it into a single indicator of something big like the health adjusted life expectancy or healthy life years. So HALE and HeaLY statistics or disability adjusted life years, and quality adjusted life. Here's the DALY and QALY. A lot of people use these in order to get good summaries across many different statistics. We won't spend a lot of time on them, but they do provide people. I think I'll one-stop-shop for looking at kind of ranking across many different mortality and morbidity statistics. While the composite measures are often helpful in summarizing many different statistics, they can sometimes be a little difficult to interpret, especially across different populations and certainly across countries. So in general, we're going to focus on using and developing the sort of single element population health indicators. They themselves can be used to create a sort of Rich Mosaic of information that we can use to glean where a population is doing well or not doing well in terms of its health. And ultimately, what we're really looking for our indicators that is going to allow us to identify priorities, communicate critical information and then encourage action and collaboration.