S. Yi1,3, S. Mukhopadhyay2,3 1George Washington University,Washington, DC, USA 2University Of Connecticut,General Surgery,Storrs, CT, USA 3Harvard School Of Medicine,Program In Global Surgery And Social Change,Brookline, MA, USA
Introduction: Traditional surgical outcomes have been measured in clinical terms such as mortality, margin of resection, or infection rates. More holistic measures such as health-related quality of life (HRQoL) have become increasingly important to capture less tangible outcomes of quality health care.
At a broader level, social indices attempt to evaluate quality of life across multiple domains. These comprehensive summary measures may better reflect effects of health outcomes (e.g. economic productivity or increased happiness). Despite the importance of these indices in social analyses, their use is poorly understood in health system prioritization. We examine these indices and assess their feasibility of use to evaluate growing surgical health systems.
Methods: We compiled leading indices from the Social Progress Imperative (Social Progress Index, SPI), UN Sustainable Development Solutions Network (World Happiness Index, WHI), UN Development Programme (Human Development Index, HDI), Organisation for Economic Co-operation and Development (Better Life Index, BLI), World Economic Forum (Global Competitiveness Index, GCI), Oxford Poverty & Human Development Initiative (Multidimensional Poverty Index, MPI), Legatum Institute (Prosperity Index, PI), and The Economist Intelligence Unit (Where-to-be-born Index, WBI). Indicators only directly related to health and medical care were extracted (Table 1). Other related indicators such as access to clean water or sanitation were not included.
Results: All eight indices included at least one measure of health. All indices but the MPI used life expectancy as a key health indicator, but differed in when it was measured (SPI at 60 years of age, the BLI at 80, 65, 60, 40, and at birth; all others measured at birth only). Three (WHI, HDI, WBI) used life expectancy at birth as the only health indicator. Five indices used infant mortality rates, while only two used maternal mortality rates, as well. Three cited undernourishment as a health indicator.
Conclusions: All examined social indices include an indicator for measuring health. Life expectancy is the most common indicator, with only the MPI excluding it. The MPI instead uses child mortality rate and undernourishment. The index with the most numerous health indicators is the PI. Interestingly, other common measures of quality health systems, such as access to timely care, workforce density, or complication rates, have not been included in these social indices. As surgery becomes a more integral component of developing health systems, it is important to utilize effective health indicators that reflect the quality of care and health that individuals experience.
