Nursing Research in Health Indicators

Health indicators are defined as the means by which one can describe either quantitatively or qualitatively an individual’s state of health or those factors that influence the health of a health system, population, or community (Atlas of Canada, 2001). Health indicators are “constructs of public health surveillance that define a measure of health (i.e., health status or other risk factor) among a specified population” (Lengerich, 1999).

In 1870, Farr, founder of modern concepts of surveillance, depicted statistics by developing graphic displays that took into account age at death (Lengerich, 1999). In so doing, Farr initiated a focus on health descriptions and analyses based on mortality and survival measures. In 1979, the U.S. Surgeon General’s Report established measurable improvement targets to be achieved by 1990 for individuals at each of the five major life stages (U.S. Department of Health and Human Services [HHS], 1998). Instead of being called Health Indicators 247 health indicators, they were referred to as goals. Subsequent publications (Healthy People 2000 &Healthy People 2010) were more comprehensive in terms of objectives and in priority areas for research and improving health. Each of these documents can be used to draw attention to benchmarks related to the health of the nation. Today, the challenge that HHS has to address is the identification of the indicators that are not only priorities, but also are reasonable in number. Additionally, more extensive work was directed to listing of leading indicators and extending the reach of HHS beyond the health community to opinion leaders, the public, and non health professionals (U.S. Department of Health and Human Services). In 1998, the Canadian Institute for Health Information (CIHI) and Statistics Canada were instrumental in launching a collaborative effort in order to ultimately share the resulting health indicators report with Canadians from province to province. More than 500 health-related individuals (providers and consumers) met to identify health information needs. A priority for this group was to establish a list of health indicators for health and health services that could be used as comparable data (Statistics Canada, 2004).

Nursing Research in Health Indicators

The list of indicators was relevant to Canadian health goals, based on standard or comparable definitions and methods, and available electronically throughout Canada. As in the United States, Canada has as a primary goal of the Health Indicators project “to support health regions in monitoring progress in improving and maintaining the health of the population and the functioning of the health system for which they are responsible...”(Statistics Canada).
Key aspects of health indicators are that they are measurable, credible, and valid, based on data that are relatively easy and economical to collect, easily understood, and capable of providing information either for communities that are geographically defined or for populations or subpopulations that are well-defined (Atlas of Canada, 2001). Ten items were listed by Healthy People 2010as leading health indicators. Leading health indicators represent the important determinants of health for the full range of issues in the 28 focus areas of Healthy People 2010 (Office of Disease Prevention and Health Pro-motion, 2002). These indicators are: physical activity, overweight and obesity, tobacco use, substance abuse, responsible sexual behavior, mental health, injury and violence, environmental quality, immunization, and access to health care (Office of Disease Prevention and Health Promotion).
The Canadian Health Indicators project resulted in the identification of the following: health status (well-being, health conditions, human function, and deaths); nonmedical determinants of health (health behaviors, living and working conditions, personal resources, and environmental factors); health system performance (acceptability, accessibility, appropriateness, competence, continuity, effectiveness, efficiency, and safety); and community and health system characteristics (community, health system, and resources) (Statistics Canada, 2004).
Health status indicators include mortality indicators (deaths and types of deaths), infectious disease indicators, maternal and infant health indicators, and community health status indicators (risk factors, access to care, preventive services use, death rates, birth measures, summary measures of health, leading causes of death, vulnerable populations, and environmental health). Other indicators are the health determinants and health outcome indicators (physical environment, poverty, high school graduation, tobacco use, weight, physical activity, health insurance, early detection of cancer, preventable deaths from injury, and disability), life course determinants (tobacco use, health care access, low birth weight, physical activity, poverty, cognitive development, substance abuse, violence, and disability), and prevention-oriented indicators (disability, preventable deaths from injury, poverty, tobacco use, childhood immunizations, cancer screening, hypertension screening, diabetes management, and health care access) (Public Health Foundation, 1999).
Several models have been set forth to reflect different but overlapping approaches to the development of health indicators. They include the Mortality Model, Health Status Model, Disparities Model, Leading Contributors Model, Focus Area Model, Summary Measures Model, Social Indicators Model, Environmental Model, Report Card Model, Index Model, Single Parameter Model, Sentinel Model, Prevention Model, Human Development (or Life Stage) Model, and Change Theory Model. Of these models, the ones that help advance the initiative of Healthy People 2010 focus on areas that need more attention (lifestyle, disparities in health, social and environmental factors that influence health) (Office of Disease Prevention and Health Promotion, 2002). Data gathered related to the health  indicators provide a basis for comparison of health status locally, regionally, and nationally.
Changes in the health status should be readily available and appropriate interventions can be initiated accordingly. Naturally, care must be taken to ensure that data that are compiled can be verified. With verified data, responsible decisions can be made in terms of health policy, health care delivery, health system management, and public  awareness of health concerns.
The overarching goals for Healthy People 2010 are to increase the quality and years of healthy life and to eliminate health disparities (Office of Disease Prevention and Health Promotion, 2002). Interdisciplinary or multidisciplinary collaboration can lead to comprehensive plans to ensure that any deficits in health status are addressed in a timely manner. Data gathered may support current health care efforts or identify areas for improvement at home, in communities, at worksites, businesses, or beyond.
In summary, health indicators serve as measures for spatial and/or temporal comparisons, help health care professionals assess health conditions, provide empirical evidence that could be used to support health programs and policies, clarify starting and endpoints for interventions, and identify extent of gaps in population or community health and well-being (Atlas of Canada, 2001).Health indicators are useful in charting progress, forecasting trends, and directing pro-grammatic attention and resources to areas that require attention (Office of Disease Prevention and Health Promotion, 2002).
Access to quality health services is a major concern, especially for those who are uninsured or underinsured. Health promotion and disease prevention are important foci that relate directly to health indicators. Ensuring appropriate care for individuals who are diagnosed with chronic disease or who have a predisposition to chronic disease is imperative. Health care education directed to diverse individuals requires heightened awareness of potential barriers in communication. Also, cultural sensitivity issues must be addressed in order to develop strategies that will overcome such barriers. 
Research areas are many and varied from health care delivery issues to health policy to health awareness. Identifying the most significant health indicators and asking researchable and meaningful questions is essential if health care providers wish to support the goals and objectives set forth by Healthy People 2010. Clearly, priorities that need attention include those that could be improved by changes in lifestyle such as smoking and obesity. Education and intervention research are major activities that could result in improved outcomes. Nurses and other healthcare providers need to keep these health indicators in mind and seek to incorporate a variety of sources when integrating and applying interventions that will potentially improve individual, population, or community health and well-being.


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