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What are the methodological issues related to measuring health and drawing comparisons across countries?

By Cristina Masseria, Sara Allin, Corinna Sorenson, Irene Papanicolas and Elias Mossialos

Abstract

Measuring population health is vital for creating effective health interventions and policies, informing resource allocation, guiding health impact assessment, and identifying the determinants of health across diverse settings. The aim of this brief is to review the methodological issues related to measuring health within and across countries and outline recommendations for improving health measurement. Population health can be measured using macro-level and micro-level indicators. While macro- or population-level data provides a broad picture or summary of health, (e.g. life expectancy, infant mortality and health-adjusted life expectancy), micro- or individual-level data comprise a variety of objective and self-assessed indicators on specific aspects or dimensions of health. Population summary measures although useful for estimating the overall population health and the global burden of disease, may provide minimal indication of the underlying factors that may be influencing health attainment in a country. While efforts have been made to combine mortality and morbidity, e.g. in healthy- and disability-adjusted life expectancy, these methods have been criticized on the grounds of methodological limitations. Avoidable mortality – or causes of death that should be avoided in the presence of timely and effective health care – represents an alternative measure of population health that can be better attributed to the health system, broader public health policies and also changes in lifestyles. On the micro-level, objective health measures such as blood pressure and body mass index are important both clinically and from a health system perspective, but they are often more expensive to collect and may be subject to measurement error. Conversely, self-assessed measures such as general health (usually ranging from excellent to poor) and limitations in daily activities although commonly available, are sensitive to variations in socio-economic conditions, individual expectations as well as wording and meaning of assessment questions. Developing an index of health on the basis of several indicators, or including vignettes in surveys are two possible methods of reducing systematic bias associated with general measures of self-assessed health. Significant advances have been made at EU-level to systematically measure health status. However improved longitudinal data is needed to make robust causal determinations about health. In addition, while extensive information is collected at national level, better international coordination of survey design and implementation would help facilitate and improve cross-country comparisons. These efforts will help to provide decision-makers with more accurate and meaningful information necessary to develop policies and programmes that most effectively address health needs and inequalities within limited resources

Topics: RA Public aspects of medicine
Publisher: European Commission
Year: 2007
OAI identifier: oai:eprints.lse.ac.uk:29835
Provided by: LSE Research Online
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