|LETTER TO THE EDITOR
|Year : 2015 | Volume
| Issue : 3 | Page : 234-235
Concept of composite health status index
Prakash Prabhakarrao Doke
Professor, Department of Community Medicine, Bharati Vidyapeeth Medical College, Pune, Maharashtra, India
|Date of Web Publication||7-Sep-2015|
Prakash Prabhakarrao Doke
Professor, Department of Community Medicine, Bharati Vidyapeeth Medical College, Satara Road, Dhanakwadi, Pune - 411 043, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Doke PP. Concept of composite health status index. Indian J Public Health 2015;59:234-5
With reference to the article by Manjiri Anand  titled "Health Status and Health Care Services in Uttar Pradesh and Bihar: A Comparative Study," I would like to state that the author has provided a method to derive a composite index for health status. The large numbers of health indicators describe specific aspects of health status. Hence, the concept of developing a comprehensive health index is a most welcome endeavor. The author has used six indicators to assess health status and develop a comprehensive index. The suggested process is similar to the calculation of the human development index. The first two indicators, Crude Birth Rate (CBR) and Total Fertility Rate (TFR), are directly fertility-related indicators. As the names suggest, CBR is the crudest estimate of fertility and TFR is the more refined indicator. Theoretically, they cannot be considered two distinct indicators. The method of considering them separately certainly leads to bias. While calculating the index and comparing the districts, a district having high fertility will get double the disadvantage, and a district having low fertility, double the benefit. Similarly, mortality is reflected thrice. Crude Death Rate is very strongly affected by age and sex distribution. Therefore, age-specific death rates are calculated. Infant Mortality Rate and Under Five Mortality Rate are nothing but specially calculated age-specific mortality rates. A high-mortality district gets a triple disadvantage and a district with low mortality obtains a triple benefit. The same scenario is thus viewed from three corners and counted thrice. Although death is an important outcome, its measurement is certainly not the only reflector of health status. Nor does it reflect a very large component of health status. How is the health status of living persons? How was the health of the persons before they died? No attempt has been made to assess the health status in this manner. Institutional delivery is basically an indicator of the utilization of health services.
Among the various factors that affect health status, the presence of a well-established health system or health infrastructure is very influential indicator. The need for calculating a separate indicator for health infrastructure is not strongly perceived. Number of doctors, number of beds, and number of nurses are certainly three distinct indicators. The authors must have considered figures from both the public and the private sector while calculating number of doctors, beds and nurses per lakh population. In that case, there is no propriety to mention number of hospitals or number of Primary Health Centers separately; because they have been indirectly counted while calculating above three indicators. Hospitals or Primary Health Centers contribute to the numbers of doctors, nurses, and beds. In the calculation of composite index for health infrastructure, too, there is tremendous overlap. Such overlap, as mentioned above, leads to advantage or benefit to certain districts. In India, multiple disciplines of practicing doctors exist: Ayurveda and homeopathy are major disciplines. It is not clear from the article whether practitioners of these disciplines have been factored in. Their inclusion or exclusion would greatly vitiate the statistics. Nonobservation of the correlation between health status index and health infrastructure index may be due to such ambiguity or overlap among selected indicators. Otherwise, the lethal conclusion may emerge that there is no need to invest in health infrastructure.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Anand M. Health status and health care services in Uttar Pradesh and Bihar: A comparative study. Indian J Public Health 2014;58:174-9.