Defining and Measuring Population Health, in Comparative Perspective

Defining and Measuring Population Health

Course Outline and Announcements

  • Class Behavior:

    • Reminder to put away phones and laptops at the start of class.

  • Readings for Next Class:

    • Yong 2022 on U.S. life expectancy in comparative context.

  • Weekly Theme:

    • Defining health and health equity, comparing health in different areas through graphs.

  • Slides Availability:

    • These slides are utilized for the current and subsequent class session.

Defining Health

  • General Definition of Health:

    • Oxford Online Dictionary (2019):

    • "The state of being free from illness or injury."

    • World Health Organization (WHO, 1948):

    • "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity."

    • Sartorius (2006):

    • "A state of balance, an equilibrium that an individual has established within himself and between himself and his social and physical environment."

Defining Health (In)equity

  • Concept of Inequity (Whitehead, 1992):

    • Definition:

    • "Inequity has a moral and ethical dimension, referring to differences that are unnecessary and avoidable, considered unfair and unjust."

    • Focus of Inequity:

    • It can refer to:

      • 1. Health outcomes: Inequities in the level and quality of health of different groups in the population.

      • 2. Health service provision: Inequities in the provision and distribution of health services.

    • Equity in Health:

    • "Equity in health implies that ideally everyone should have a fair opportunity to attain their full health potential."

    • The aim of policy:

      • Not to eliminate all health differences, but to reduce or eliminate those resulting from avoidable, unfair factors.

Nuances of Word Choice

  • Terminology Implications:

    • Difference:

    • Neutral with respect to unfairness.

    • Inequality and Disparity:

    • May suggest unfairness; disparity typically implies it in the U.S.

    • Inequity:

    • Implies unfairness, commonly used in Europe.

Some Measures of Health (and Inequality)

  • Common Metrics Used:

    • Life Expectancy ($e0$, sometimes $e{65}$, etc.).

    • Infant Mortality Rate (IMR):

    • Note: WHO metrics per 1000, some sources per 100,000.

    • Under-Five Mortality Rate (U5MR).

    • Gini Coefficient:

    • Measures income inequality:

      • 0 = Complete equality

      • 1 = Complete inequality

Global Income Inequality (Gini Coefficient, 2023)

  • Measurement Context:

    • Income inequality measured before taxes and benefits, but after paying public/private pensions.

  • Data Sources:

    • World Inequality Database.

Health Disparities Graphs

  • Visual representations of health disparities highlighting the differences across regions or groups.

Life Expectancy Around the World (2022 Data)

  • Top Countries by Life Expectancy:

    • 1. Macao (85.4 years)

    • 2. Liechtenstein (84.3 years)

    • 3. Japan (84 years)

    1. OECD Average (79.6 years)

    1. Cuba (78.2 years)

    1. U.S. (77.4 years)

Infant Mortality Rate (IMR) Around the World (2023 Data)

  • Definition:

    • The share of newborns who die before their first birthday.

  • Comparative Rankings (2024 CIA Data):

    • Singapore: 1.5 per 1,000

    • Japan: 1.9

    • Belarus: 2.1

    • Cuba: 4.0

    • U.S.: 5.1

    • China: 6.2

    • Russia: 6.5

    • Globally, 54 of 227 countries have lower IMRs than the U.S.

U.S. Infant Mortality Compared to Other Developed Countries (2021 Data)

  • U.S. Ranking:

    • Ranks No. 33 out of 38 OECD countries in infant mortality.

  • Notable Statistics:

    • Variation exists among U.S. states.

Life Expectancy at Birth Comparisons (2023 Data)

  • U.S. Ranking Globally:

    • Ranks #55 out of 210 countries.

Political Context on Equality of Opportunity vs. Equal Results

  • Heritage Foundation Statements (2012):

    • Highlights the debate between conservative and liberal views on equality of opportunity versus equal outcomes.

  • Trump Administration's Stance (April 2025):

    • Emphasis on equality of opportunity over equal outcomes, cautioning against perceived movements that equate outcome differences with discrimination.

U.S. Health Compared to Other Wealthy Countries (Insights from Yong 2022)

  • COVID-19 Impact:

    • Revealed systemic issues related to high mortality rates in younger populations.

    • An average of one-third of deaths might have been prevented if U.S. performed similarly to other wealthy countries.

Prioritization of Health Across Ages

  • Discussion on why individuals seek medical treatments in the U.S. despite lower life expectancy.

  • Life expectancy is adaptable based on the age of calculation ($e_0$ or other age)$.

U.S. State-Level Differences in Health Metrics

  • Illustrative maps comparing state life expectancies to other global regions/countries.

Classifying Causes of Death

  • Categories of Death Causes:

    • Infectious/Communicable Diseases:

    • Causes: bacteria, viruses, parasites, fungi (e.g., malaria, tuberculosis, Ebola, COVID-19).

    • Chronic/Non-Communicable Diseases:

    • Tied to aging and health habits (e.g., heart disease, diabetes, cancer).

    • Violent Causes of Death:

    • Includes war, traffic fatalities, homicide, suicide.

Epidemiological Transition (Omran 1971)

  • Historical Overview:

    • 19th century marked by infectious diseases and starvation as primary causes of death.

    • Modern transitions to chronic diseases as primary causes of death in wealthier countries.

Mortality Patterns and Health Profiles

  • Implications of Death Causes:

    • Countries with high infectious disease deaths typically have not undergone the epidemiological transition.

    • Countries with chronic disease deaths are often wealthier.

Interpreting Top Causes of Death - Comparison Exercises

  • Activities designed to deduce health profiles based on top causes of death.

Terminology for Categorizing Countries

  • Outdated Terms and Contexts:

    • "First World" vs. "Third World" (historically 1952 based terms).

    • Modernized terms including MDCs (more developed countries), LDCs (less developed countries), Global North/South, Developed/Developing categories.