Measures of Health Status. The key terms..

MEASURING
HEALTH STATUS
– KEY TERMS

HEALTH STATUS
Key knowledge:
• Indicators used to measure and understand health status: incidence, prevalence,
morbidity, burden of disease, disability-adjusted life year (DALY), life expectancy,
health-adjusted life expectancy (HALE), mortality (including maternal, infant and
under 5) and self-assessed health status
Key Skills:
• Describe and apply indicators used to measure health status of Australians
• Use data to describe and evaluate the health status of Australians.

HEALTH STATUS
Health status:
‘An individual’s or population’s overall level of health, taking into account
various aspects such as life expectancy, amount of disability, levels of disease
risk factors’ (Australian Institute of Health and welfare).
Health indicators:
‘Standard statistics that are used to measure and compare health status (e.g.
life expectancy, mortality and morbidity rates)

SELF-ASSESSED HEALTH STATUS
• What is ‘Self-Assessed Health Status?’
‘An indicator that reflects a person’s perception of his or her own
health and well-being at a given point’
• Data is often collected from population surveys
• Participants are asked to classify their health status according to five
levels (excellent – poor)

LIFE EXPECTANCY
• Life expectancy is the most commonly used indicator of a population’s health:
‘An indication of how long a person can expect to live, it is the number of years of life
remaining to a person at a particular age if death rates do not change’
Males Females
Life expectancy (2003-05) 78.5 83.3
Life expectancy
(2015)
80.4 84.5

Measures of Health Status. The key terms..

LIFE EXPECTANCY - LIMITATIONS
• Life expectancy is a useful health indicator particularly when
comparing countries or population groups
• Life expectancy however does not give an indication of the quality of
life .

HEALTH ADJUSTED LIFE
EXPECTANCY (HALE)
A measure of burden of disease based on life expectancy at birth, but
including an adjustment for time spent in poor health. It is the number
of years of full health that a person can expect to live, based on current
rates of ill health and mortality
Males Females
Life expectancy (2015) 80.4 84.5
Health adjusted life
expectancy (2015)
70.8 72.9
(Difference) 9.6 years 11.6 years
Health adjusted life
expectancy is often
referred to as
‘healthy life
expectancy’

IN SUMMARY: HEALTH-ADJUSTED
LIFE EXPECTANCY
• Refers to the number of years a person can expect to live
without reduced functioning (including decreased mobility
and the decline in the functioning of body systems) due to
ill health
• It is an indicator of both quantity and quality of life

HEALTH ADJUSTED LIFEYEARS
(HALE)
• Can be remembered by the below equations:
HALE = life expectancy – number of years living in unhealthy states
• Health years: years living free from disability or disease
HALE
Life expectancy
Number of
years living in
unhealthy
states

QUESTIONS
1 a).What is meant by ‘health status’?
b). How is health status measured?

ANSWERS
a).An individual’s or a population’s overall health, taking into
account various aspects such as life expectancy, amount of
disability and levels of disease risk factors.
(1 mark)
b). Health status is measured using a range of health indicators
such as self-assessed health status, life expectancy, morbidity,
mortality and burden of disease.
(1 mark)

QUESTIONS
2. Explain what is meant by self-assessed health
status.

ANSWERS
2. Self-assessed health status relates to how individuals
feel about their own level of health and wellbeing. Self-
assessed health status data is often collected from
population surveys and provides an indication of the
overall level being experienced in relation to physical,
social, emotional, mental and spiritual health and
wellbeing. (2 marks)

QUESTIONS
3. Explain the difference between life
expectancy and health-adjusted life
expectancy as health status indicators.

ANSWERS
3. Life expectancy relates to the number of
years a person can expect to live (quantity of
life) whereas health-adjusted life expectancy
refers to the number of years a person can
expect to live in good health (quality of life).
(2 marks)

QUESTIONS
4 a).According to figure 2.6, what was
the life expectancy and health-adjusted
life expectancy for males and females
in Australia respectively?
b).What do these numbers mean in
relation to quantity and quality of life
for males compared to females?

ANSWERS
4 a). Life expectancy and healthy life expectancy for males are 80.5 and
71.8 respectively, and for females they are 84.6 and 74.1 respectively.
(1 mark)
b). Females live longer on average than males, and females spend more
time experiencing ill health than males (10.5 years for females
compared with 8.7 years for males).
(1 mark)

QUESTIONS
5 a).What is a trend?
b). Identify two trends evident in figure 2.5.

ANSWERS
5 a).A trend is a general pattern or movement in a particular
direction.
(1 mark)
b). Females have consistently had a higher life expectancy than
males (around five years more), and the life expectancy for both
males and females has increased over time from around 48 for
males and 50 for females in 1890 to around 80 for males and 84
for females in 2016.
(2 marks)

APPLICATION QUESTIONS
1 a).Which dimension of health and wellbeing is
generally the focus of health statistics?
b).Why would this be the case?
c). Identify a health status indicator that may reflect
multiple dimensions of health and wellbeing and justify
your choice.

ANSWERS
1a). Physical health and wellbeing
(1 mark)
b). Data on physical health and wellbeing (such as deaths and illness) are
easier to collect than data on social, emotional, mental and spiritual health
and wellbeing.
(1 mark)
c). Self-assessed health status, as this is based on an individual’s
interpretation of overall health and wellbeing, which may include all five
dimensions.
(2 marks)

2. Outline the difference between health and
wellbeing and health status.

ANSWERS
2. Health and wellbeing relates to the five
dimensions, whereas health status relates to
health indicators such as life expectancy and
morbidity rates.
(2 marks)

3. Brainstorm reasons why self-assessed health
status may not be completely accurate in
measuring the health status of a population.

ANSWERS
3. Examples include:
• Some people may not be completely honest in their
response to their self-assessed health status.
• This is a subjective concept and one person may see
themselves as healthy if they are not sick and another
may not see themselves as healthy if they are not
performing at their highest possible level.
• (1 mark)

4. a) Outline the relationship between age and the
proportion of those assessing their health and
wellbeing as excellent or very good according
to figure 2.3.
b). Suggest reasons that may account for the
relationship outlined in part (a).

ANSWERS
4 a).The proportion of those assessing their health status as either
excellent or very good decreases as age groups increase; from
around 63 per cent of those aged 15–24 to around 35 per cent of
those aged 75+.
(1 mark)
b).As people get older, their bodies often don’t function as well as
they once did.They may have chronic conditions, or they may have
lost a spouse and so on.
(1 mark)

5.‘Life expectancy will continue to rise in the
future’.To what extent do you agree with this
statement?

ANSWERS
5. For example:
I disagree with this statement. Lifestyle-related issues such as obesity
continue to increase.This will contribute to higher rates of some cancers
and cardiovascular disease which can decrease the ability of people to live
long lives.
I agree with this statement. Medical technology and education continue to
improve and more and more conditions (such as cancer) can now be treated
more effectively, meaning people are less likely to die prematurely, increasing
life expectancy.
(2 marks)

6. Suggest reasons that might account for the
lower life expectancy experienced by men
compared with that of women.

ANSWERS
6. Men may take more risks, are more likely to be overweight,
and are less likely to visit a doctor than females.They may be
more likely to smoke or drink at risky levels and engage in
violence.There may be genetic factors that account for the
differences.Any of these factors could lead to a lower life
expectancy.
(3 marks)

7. Explain why life expectancy is higher for
those aged 60 compared to those at birth.

ANSWERS
7. Life expectancy is based on averages. If someone makes
it through childhood, their life expectancy goes up as
some won’t make it and they bring the average at birth
down. If someone makes it to 60, it is expected that they
will live beyond the life expectancy for someone at birth.
(2 marks)

MORTALITY
‘Mortality refers to deaths particularly in a
population’
Mortality rate the measurement of the
proportion of a population who die on a one
year period (usually per 100 000)

WHY??????
• Why is it useful to identify the leading causes of death?
• Why have the leading causes of death changed over the past century?
• Why have deaths from infectious diseases, cervical cancer and motor
vehicle accidents decreased?
• Why have mortality rates from type 2 diabetes and dementia
increased?

INFANT MORTALITY/UNDER-FIVE
MORTALITY RATES
• Mortality rates for infants and children are key indicators of the
general health and wellbeing of a population
• Reflect the social and economic resources
• Infants rely on others to meet their basic needs of food, water and
healthcare
• Susceptible to infections and illnesses due to their underdeveloped
immune systems

MATERNAL MORTALITY RATE
‘Relates to the deaths of mothers as a result of pregnancy or childbirth,
up to six weeks after delivery’
• Leading causes include cardiovascular disease and obstetric
haemorrhage.

QUESTIONS
1. List the top three causes of death for men and
women.

ANSWERS
1. The top three causes of death for males are
coronary heart disease, lung cancer, and
dementia and Alzheimer disease.The top three
causes of death for females are dementia and
Alzheimer disease, coronary heart disease and
cerebrovascular disease (including stroke).
(2 marks)

QUESTIONS
2 a). How have the causes of death changed over
the past century in Australia?
b). Brainstorm factors that may have contributed
the change outlined in part (a).

ANSWERS
2a).The main causes of death have shifted from infectious diseases to
lifestyle diseases. Deaths from conditions such as influenza and
tuberculosis were common in the past but not so much these days.
Lifestyle-related diseases and conditions associated with advancing
age such as dementia, cancer and type 2 diabetes have increased.
(2 marks)

ANSWERS
b). Possible reasons include:
• Advances in medical technology, such as vaccinations, have resulted in many infectious diseases
declining.
• An ageing population means more conditions associated with older age have increased.
• Increasing rates of obesity have contributed to many lifestyle-related diseases.
• Changes in diet have contributed to an increase in diet-related diseases such as
type 2 diabetes.
• More sedentary lifestyles have contributed to increased rates of obesity and associated
conditions.
• (3 marks)

QUESTIONS
3. Explain why the mortality rates for infants and
children are key indicators of the general health and
wellbeing of the population.
4. Outline the difference in causes of mortality for
infants compared to 1–4 year olds.

ANSWERS
3.They reflect the social and economic resources available. Infants and children rely
on others to meet their needs for food, water and healthcare, and they often have
underdeveloped immune and other body systems which make them particularly
susceptible to premature mortality. If children are surviving, it generally means that
these resources are available, and this indicates that the general health and wellbeing
of the population is positive.
(2 marks)
4. Leading causes of death for infants include congenital malformations, SIDS and
accidental threats to breathing. For children aged 1–4 years, the leading causes are
injuries, cancers and diseases of the nervous system.
(2 marks)

1. Outline two trends as shown in figure 2.7.

ANSWERS
1. Mortality rates have decreased for both males and
females between 1907 and 2017, from around 2250 to
around 650 per 100 000 for males, and from around
1800 to around 450 per 100 000 for females. Females
have always had a lower mortality rate than males, for
example, around 450 per 100 000 for females in 2017
and around 650 per 100 000 for males at the same time.
(2 marks)

2. Outline the
change in infant
mortality rates for
males and females
that occurred
between 2006 and
2017 in Australia
according to figure
2.11.

ANSWERS
2. Infant mortality rates decreased for both males and
females between 2006 and 2017, from around 5.2 and 4
per 1000 live births to around 3.5 and 3 per 1000 live
births respectively.
(2 marks)

3. Outline the change in the under-five mortality
rate over time according to figure 2.14.

ANSWERS
3.The U5MR has decreased from around 9 per
1000 live births in 1990 to around 3.5 in 2017.
(1 mark)

4 a).Approximately
how many maternal
deaths were there in
2012–14 according
to figure 2.16?
b).Approximately what
was the maternal
mortality ratio in 2012–
14 according to figure
2.16?

ANSWERS
4 a).There were around 63 maternal deaths in
2012–14.
(1 mark)
b).The maternal mortality ratio was around 7 per
100 000 women who gave birth in 2012–14.
(1 mark)

MORBIDITY
‘Morbidity refers to ill health in an individual and the levels of
ill health in a population or group (AIHW)
Morbidity rate is a measure of how many people suffer from
a particular condition during a given period of time
Morbidity rates for many causes have increased whilst
some mortality rates have fallen.WHY?

MEASURES OF MORBIDITY:
PREVALENCE AND INCIDENCE
Prevalence: The number or proportion of cases of
a particular disease or condition in a population
at a given time
Incidence: The number or rate of new cases of a
particular disease during a specified period of
time (usually a 12 month period)

DISCUSSION
‘Breast cancer — incidence up,
death rate down, survival rates
improve’. Is this headline possible?

QUESTIONS
1. Explain the difference between incidence and
prevalence.

ANSWERS
1. Incidence refers to the number or rate of
new cases of a disease during a specified
period of time (usually a 12-month period),
whereas prevalence refers to the total
number of people experiencing a condition
at a given time (usually a 12-month period).
(2 marks)

QUESTIONS
2. Explain why morbidity rates have
increased as mortality rates have decreased.

ANSWERS
2. As mortality rates decrease, people live
longer, which makes them more likely to
experience ill health from conditions such
as cancer, cardiovascular disease and
dementia.
(1 mark)

QUESTIONS
3. a) Briefly outline the overall change in rates of
overweight and obesity between 1995 and 2014–15
according to figure 2.22.

ANSWERS
3. Trends
a. The prevalence of overweight and obesity
increased in all age groups between 1995 and
2014‒15 (by around 15 per cent for those
aged 18–24 and around 35 per cent for those
aged 75 and over).
(1 mark)

QUESTIONS
b) Suggest factors that may have led to these
trends.
c)Which age groups are most likely to be
overweight or obese according to this figure?

ANSWERS
b) Possible factors include:
 People are less active and are consuming a more energy dense food
intake than in the past.
 Those who are overweight or obese may be less likely to live to over
75 years of age, which would decrease the prevalence of overweight
and obesity in this age group.
 Those aged over 75 may have illnesses that cause them to lose weight.
 Those aged over 75 may experience a decrease in appetite which may
decrease rates of overweight and obesity in this age group.
(2 marks)
c) Those in the 55‒64 age group are most likely to be overweight or
obese. (1 mark)

QUESTIONS
4 a) List one difference
between the long-term
conditions of males and females
as shown in table 2.3.
b) Suggest factors that may
have led to this difference.

ANSWERS
4 For example:
a) Deafness occurs in more males than females (13.9
per cent for males and 8.3 per cent for females).
(1 mark)
b) Males may be exposed to louder noises in their
jobs; for instance, more hearing problems might be
experienced in industries such as construction.
(1 mark)

1.When looking at morbidity
rates, why is it important to
consider both incidence and
prevalence rates?

ANSWERS
1. Incidence gives an indication of how many new cases were
reported in a given period and prevalence tells how many people
suffer from the condition in total. Without incidence data, it is not
possible to identify emerging trends in the condition. Consider
cancer. The prevalence rates alone for cancer indicate how many
people require ongoing treatment and therefore provides essential
information for health budgets, but does not show how many
people are being newly diagnosed with the condition. If incidence
rates increase, a strategy could be put in place to target the cancers
that are increasing which could assist in preventing some cases.
(2 marks)

2. a)Why might females be more likely to
visit doctors?
b)What consequences does this have on
the health status of males versus females?

ANSWERS
2 a) Females may be more concerned with their health than males and be more likely
to visit a doctor for a check-up. Females may also be more likely to visit a doctor as a
result of reproductive issues and pregnancy.
(1 mark)
b) This may mean that females’ health is more closely monitored than that of males.
As a result, males may have conditions that go undiagnosed and lead to further
complications (such as hospitalisation and even death). Males may also miss out on
valuable health information that may have been passed on from a doctor. As a result
of all these factors, the health status of females could be better.
(2 marks)

3. Describe how increasing rates of obesity
could have a large impact on mortality and
morbidity statistics in the future.

ANSWERS
3. Obesity can contribute to a range of other health
conditions such as depression, cardiovascular
disease and diabetes. These conditions require
treatment and management, and can contribute to
death. As obesity rates increase, the number of
people experiencing these associated conditions will
also increase, therefore impacting on morbidity and
mortality rates.
(2 marks)

4. How could living with cancer affect
mental and spiritual health and wellbeing?

ANSWERS
4. Cancer can affect mental and spiritual health and wellbeing in
many ways. The person may feel depressed as a result of being sick
and having to undergo treatment. They may have to stop working
and participating in everyday activities, which might make them
feel frustrated. They may think about the possibility of dying, which
can also impact on their mental health and wellbeing. Spiritually,
they may feel that the disease is out of their control which can
promote a sense of peace and harmony. They may experience a
renewed desire to work towards their purpose on life.
(4 marks)

BURDEN OF DISEASE
A measure of the impact of diseases and injuries, specifically it
measures the gap between current health status and an ideal
situation where everyone lives to an old age free of disability
and disease.
• Burden of disease is measured in a unit called the
disability-adjusted life year or DALY (one DALY = 1 year
of life lost due to premature death or the equivalent time
of healthy years lost as a result of living with a disease or
disability)

YEARS OF LIFE LOST (YLL)
A measure of how many years of expected life are lost due to
premature death
• These are the fatal component of DALY
• EachYLL represents one year of life lost due to premature
death.
• For example: If a person dies at 60 from a car accident , and life
expectancy for a 60 year old is 85, then 25 years of life have
been lost.

YEARS OF LIFE LOST DUE TO
DISABILITY (YLD)
A measure of how many healthy years of life are lost
due to illness, injury or disability
• Years lost due to disability (YLD) are the non-
fatal component of DALY
• A complex formula is used for this calculation

DISABILITY ADJUSTED LIFEYEAR (DALY)
• One DALY is the equivalent of one healthy year of life lost
• Calculating burden of disease
YLL =Years of life lost
YLD =Years of life lost due to a disability
DALY
YLL YLD

YLL ANDYLD COMPARISON
• BothYLL andYLD have equal value – one
year
• YLL is premature death whereasYLD is
from illness, injury or disability

QUESTIONS
1 a) What is meant by the term ‘burden of
disease’?
b) What is the benefit of using burden of
disease as a health indicator?
c)What is the unit of measurement for
burden of disease data?

ANSWERS
1 a) Burden of disease is a measure of the impact of diseases and injuries. Specifically it measures
the gap between current health status and an ideal situation where everyone lives to an old age
free of disease and disability.
(1 mark)
b) Burden of disease data is useful as a health indicator because some conditions, such as
arthritis, affect a large number of people but don’t cause death. Burden of disease data allows
such conditions to be compared to those that do cause death.Also, some conditions cause death
mainly in older people (such as prostate cancer) and the impact of these conditions can be
compared with conditions that generally cause death in younger people (such as breast cancer).
(1 mark)
c) Disability adjusted life years (DALY)
(1 mark)

QUESTIONS
2 a)What is one DALY equal to?
b) How are DALY calculated?

ANSWERS
2 a) One DALY is equal to one ‘healthy’ year of life
lost due either to premature death or time lived
with injury, illness or disability.
(1 mark)
b) DALYs are calculated by adding YLL (years of
life lost) with YLD (years of life lost due to
disability).
(1 mark)

QUESTIONS
3. Explain the difference betweenYLL and
YLD.

WHEN DISCUSSING HEALTH AND WELLBEING, ONE OR MORE OFTHE DIMENSIONS
SHOULD BETHE FOCUS.WHEN DISCUSSING HEALTH STATUS,THE HEALTH STATUS
INDICATORS SHOULD BE THE FOCUS. FOR EXAMPLE, IF DISCUSSING HOW
EDUCATION CAN INFLUENCE HEALTH ANDWELLBEING AND HEALTH STATUS,THE
RESPECTIVE ANSWERS COULD BE:
EXAMTIP
Health and wellbeing — educated individuals are more likely to understand the benefits
of being socially connected and may therefore invest time in socialising which can
enhance the quality of relationships and promote social health and wellbeing [shows link to
health and wellbeing].
Health status — education can mean that people have a greater understanding of healthy
eating.This can promote healthy food intake which can promote healthy body weight and
reduce the prevalence of cardiovascular disease. In turn, this can decrease rate of
premature mortality from causes such as heart attack and increase life expectancy [shows
links to health status].

ANSWERS
3. YLL v YLD
 One YLL (year of life lost) is equal to one year of life lost due
to premature death. For example, if life expectancy is 80 and
a person dies at 75, five years of life (YLLs) have been lost.
 One YLD (year of life lost due to disability) is equal to one
‘healthy’ year of life lost due to disability. For example, if a
person lives for 10 years in only ‘half health’ due to arthritis,
then five years of healthy life have been lost (i.e. 5 YLD).
(2 marks)

1. Explain how one condition can cause
more deaths yet contribute fewerYLL than
another condition.
2. Describe how the social health and
wellbeing of an individual may be affected
when suffering from cancer.

ANSWERS
1.The average age of death from one condition (condition A) may be lower than for another
condition (condition B). So, if a person dies at 50 from condition A and another person dies at
60 from condition B, condition A will have an extra 10 years ofYLLs added compared to
condition B. So, more people could die from condition B, but it could contribute fewerYLL than
condition A.
(2 marks)
2.The person suffering from cancer may stop working, which means they will not have the
usual social interactions at work.They may lack energy, which can make socialising difficult.
However, visits from family and friends may enhance their social health and wellbeing, and they
may make new friends and support groups in hospital.
(2 marks)

QUESTIONS
3. If you were the Minister for Health and could
select three conditions on which to focus resources,
which would you pick? Justify your choice.
4.Which health indicator do you believe provides the
most accurate picture of health status in Australia’s?
Justify your choice.

ANSWERS
3. Individual response. For example:
Cancer would receive the greatest amount of resources because it has the
greatest burden on Australia society. Second would be mental and substance
use disorders as this contributes the second greatest burden overall. Injuries
would be third as they contribute the third greatest burden overall.
(1 mark)
4. Individual response. For example:
Burden of disease as it takes both mortality and morbidity into account. It also
allows for the average age at death and the severity of the conditions that do
not contribute to death, making it the most comprehensive indicator.
(2 marks)

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