Methodological Summaries in Epidemiology:
Health Situation Analyses
What is meant by health situation analysis (HSA)?
What are the purposes of HSA?
Which are the different types of HSA?
Measuring inequity in health
What is meant by health situation analysis?
Health situation analyses (HSA) are analytical-synthetic processes
that encompass various types of analysis. HSA make it possible to characterize,
measure, and explain the health-disease profile of a population, including
illnesses, injuries and other health problems and their determinant factors,
whether they are the responsibility of the health sector or of other sectors.
The HSA also facilitate the identification of needs and priorities in health,
as well as the identification of interventions and appropriate programs
and the evaluation of their impact on health.
HSA are based on the study of the interaction of the living conditions and
the existing level of the health processes of a country or any other geographic-political
unit. HSA include as substrata population groups with different degrees
of neglect, resulting from unequal living conditions and quality of life
and defined according to specific characteristics such as sex, age, occupation,
etc., that occur in specific environments. The environment constitutes the
historical, geographical, demographic, social, economic, cultural, political,
and epidemiological context of the human groups, where complex relations
of determination and effect exist.
What are the purposes of HSA?
The HSA have various purposes and their importance resides in contributing
the information that the technical component requires for directing, management,
and decision-making processes in health. In particular, the purposes are
to support in:
- Definition of needs, priorities, and policies in health and the evaluation
of their relevance.
Figure 1
exemplifies the assessment of social needs of geostatistical units, using high
population density, crowding and limited access to water at home as indicators,
and identifies priority areas, where higher levels of those factors co-exist,
in the city of Guadalajara, Mexico. Although the distribution patterns of high
levels of the indicators towards the periphery are similar, when a condition
to identify all three in a single geographic unit was set, only a few units
were selected.
Figure 2 shows changes in the risk of meningococcal disease in Cuba at the local level after the introduction of universal vaccination. Overall, a decrease was observed, but areas of persistence were seen in the central and eastern areas of the country, a finding that deserves further study. - Construction of prospective health scenarios.
Figure 3 displays the 1950-1995 trends of infant mortality rates for 5 groups of countries of the Americas, classified according to gross national product per capita in 1995,Group I being the most affluent and V the least. An overall decrease of mortality in the Region was observed in all groups. However, countries in group V had not reached in 1995 what was occurring in Group I in the 1950-1954 period and the pace (slope) of change has been more dramatic in the opposite direction, being faster in the least and slower in the most affluent ones.
That is, the HSA serve for political negotiation, institutional management,
resource mobilization, and the dissemination of health information. The principal
goal of the HSA is to contribute to the rational decision-making for the satisfaction
of the health needs of the population with a maximum of equity, efficiency,
and social participation.
Which are the different types of HSA?
There are several types of analysis, among them the analyses of trends and
the analyses of situation. The first have as their purpose to identify and to
determine the conditions of changes in the health-disease processes of a population,
usually in the medium and long term. In turn, the situation analyses respond
to a context and short-term defined situations that make it possible to orient
courses of action depending on conditions of viability and feasibility of the
existing political situation.
Measuring Inequity in Health
Inequity in health is expressed in the structure and level of the health-disease
profile of the various population groups. This results from their exposure to
risk factors that are related to living conditions, their control of exposure,
their access to health services and their opportunity to participate in the
decisions with respect to the management of those services. The HSA will have
characteristics that will depend on the level of aggregation of the information,
whether they are carried out at the national, regional or local level.
For example, the trends of infant mortality of a country in a period can be
analyzed, comparing them with the Region of the Americas (Figure
4). The progress of mortality in a country can also be defined according
to its causes, considering that the quality and access to the health services
will affect more the perinatal causes, while the living conditions will have
a more important effect on communicable diseases (Figure
5).
Another example to analyze, for its effect on health, is the evolution and distribution
of the wealth of the Region of the Americas in relation to the gross national
product (GNP), specifically the highest 20%/lowest 20%income ratio (Figure
6). The gaps can be analyzed between countries, the geographical pattern
by subregions, and their relation to levels of life expectancy at birth (Figure
7).
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Epidemiological Bulletin, Vol. 20 No. 3, September
1999