งานนำเสนอเรื่อง: "National Health Foundation"— ใบสำเนางานนำเสนอ:
1National Health Foundation Health MeasurementFrom outcome to systemSomsak ChunharasSecretary GeneralNational Health Foundation
2Measuring health development Health outcome = classic setDiseases burden (DALY) = diseases “outcome”Quality of life (comprehensive “outcome” definition, multi-sectoral dimension)Health (care) system performance/developmentSocial determinants of health (+equity concern)health measurement
3Life expectancy at Birth YearMaleFemale67.3671.7468.1572.3968.8673.00Source: National Population Estimates, : National Economic and Social Development Board, 2003.health measurement
4Life expectancy, 2004 Life expectancy Male Female At birth 66.1 74.1 At 60 years18.020.9At 80 years10.010.2Source: Population Gazette, 2005, IPSR Mahidolhealth measurement
5Crude death rate,Source: UN, World Population Prospects, The 2000 Revisionhealth measurement
6Crude death rates, with and without HIV/AIDS, 1985-2010 Source: Rhucharoenpornpanich and Chamratrithirong ,health measurement
7Reference: Thailand Health Profile, (Wibulpholprasert et al, 2004). Total fertility rate,health measurementReference: Thailand Health Profile, (Wibulpholprasert et al, 2004).
8Infant Mortality Rate, 1964-2020 health measurementReference: Thailand Health Profile, (Wibulpholprasert et al, 2004).
9Population growth rate, 1970-2020 health measurementReference: Thailand Health Profile, (Wibulpholprasert et al, 2004).
24Relations between functions and objectives of a health system health measurement
25From Functions to Health System Outcomes health measurement25
26hsc.csu.edu.au/.../improving/3-2/3-2-3/view.gif 24-09-08 health measurementRoad and traffic related injuriesSocial determinantshsc.csu.edu.au/.../improving/3-2/3-2-3/view.gif
27Dahlgren G, and Whitehead M in the Acheson Report (1998) health measurement
28Figure 1 demonstrates one way of representing the interaction between lifestyle, cultural and socio-economic conditions, crime, education, housing,transport, employment issues and health.The present (Australian) government have accepted that some of thewider determinants of health are: Poverty Employment Education Housing Accidents Social Capitalhealth measurement
30เมืองน่าอยู่ เอกลักษณ์ ลักษณะ WHO 24-09-08 health measurement คนสุขภาพดีเจ็บป่วยน้อยเสมอภาค/สะดวกในการเข้าถึงบริการสุขภาพสภาพแวดล้อมที่อยู่อาศัยสะอาด - ปลอดภัยลักษณะเมืองน่าอยู่การพัฒนากลมกลืนอดีตเศรษฐกิจหลากหลายมีชีวิตชีวาเอกลักษณ์ความเชื่อมโยงทางวัฒนธรรมระบบนิเวศน์สมดุลความจำเป็นพื้นฐานพอเพียงWHOชุมชนเข็มแข็งประชาชนมีส่วนร่วมควบคุม-กำหนด-ตัดสินใจการเข้าถึงการรับรู้ข้อมูล/ข่าวสาร/การติดต่อhealth measurement
31Equity determinants/differential Table 2: Dimensions of health to consider when comparing more and less advantaged social groupsDimensions of health Health status,includingdisease,mortality, qualityof lifeAccess toandutilisation ofhealth careservicesHealth carefinancingand resourceallocationQuality of healthcare delivery invariouscategories,(e.g., MCH,communicablediseases, trauma,mental health)Access/exposure tounderlyinghealth determinants- Water/sanitation- Nutrition/food security- Formal education- Environmental oroccupational hazards- Behavioural risk factorsTheconsequencesof poor health onsocial andeconomic statusSocial groups to compareSocio-economic (rich /poor; level of education;occupation)Race and / or ethnicityReligionLanguageGenderGeography (rural /urban; regions; slums/other urban areas)National originSexual orientationAgeDisabilityOther social groups thatare excluded or marginalizedEquity determinants/differential• Socio-economic status (reflected by income, expenditures, accumulated economic assets, occupation, or education level)• Race/ethnicity, religion, and/or language• Gender• Geography (e.g. urban–rural, or different provinces, districts, villages, or urban neighbourhoods)health measurement
32Equity determinants/differentials • National origin (e.g. comparing immigrants/refugees with local nationals)• Age (e.g. the elderly and children experience social disadvantage in many societies)• Sexual orientation• Disability (including direct effects of physical or mental disabilities as well as societal attitudes that lead to further social and/or economic exclusion)• Other characteristics that define marginalised or disempowered populations.health measurement
33Indicators for equity gauge • Health outcomes e.g., illness/disease/injury rates, mortality rates, quality of life, and major risks to health• Health care financing and health care resource allocation• Access to and utilization of health care services (actual use of recommended services is the most valid way to measure access)• Quality of health care services• Access/exposure to underlying determinants of health, e.g., poverty, nutrition and food security, behavioural risk factors such as smoking and unprotected intercourse, and exposure to occupational or environmental hazards• Social and economic consequences of ill health, e.g. impoverishment due to ill health, or economic exclusion or stigmatisation due to HIV infection.health measurement