Summarizing Population Health Directions For The Development And Application Of Population Metrics by Marilyn J Field And Marthe R Gold

Description

  

Historically,

policies to improve population health have focused on major causes of

death such as smallpox and cholera. Policy priorities have, in turn,

been guided by information on mortality and life expectancy, and

governments and others have worked to collect comprehensive, reliable,

and valid mortality data. As death rates have decreased and life spans

have lengthened, however, people have become increasingly interested in

other health goals such as preventing disability, improving

functioning, and relieving pain and the distress caused by other

physical and emotional symptoms. With broader goals, policymakers need

additional information to help them make decisions and establish

priorities for public health, biomedical research, and personal health

services.

  

For some purposes and decisions such

as making individual patient care decisions or reducing postoperative

infection rates, detailed clinical, behavioral, and organizational

information is required. For other purposes such as understanding broad

trends in the public's health or comparing the value of population

health promotion strategies, it is helpful to have some overall picture

or summary measure of health and well-being in addition to information

on specific aspects or dimensions of health.

  

The

development and application of summary measures of population health

present complex and intriguing methodological, ethical, and political

challenges. Methodologists have taken the lead in confronting these

challenges, for example, in devising ways to summarize in a single

measure the impact on population health of both mortality and

morbidity. They generally have used one of several different methods to

attach a single number梪sually ranging between 0 (death) and 1 (optimal

health)梩o a complex of social and personal attributes that represent

health status. This number has then been linked to life expectancy to

form a single integrative measure of overall health. Under the overall

measurement rubrics of health-adjusted life years (HALYs) or

health-adjusted life expectancy (HALE), several kinds of measures have

been developed. The best known include quality-adjusted life years

(QALYs), years of healthy life (YHLs), and disability-adjusted life

years (DALYs). Methodologists are still refining these measures to

improve their reliability, validity, credibility, and ease of use.

  

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