Population-based health indexes: a systematic review

This paper presents a systematic review the literature pertaining to the development and use of population-based health indexes with regard to reason for development of the index, geographical level of aggregation, inclusion of health indicators, weighting, sources of data and validation. Any type of population-based health index that incorporated at least two health indicators was considered for inclusion in the review. Studies from the UK, Europe and North America were considered. Seventeen individual studies and one review describing a population-based health index are described. The health indexes were designed for a wide variety of purposes. Levels of geographical aggregation ranged from ward to national level. There was considerable variation between these studies regarding the indicators chosen for inclusion in the health indexes as well as the methods used to combine them. Fourteen of the 18 included studies reported information on weighting of the indicators. None of the studies gave justification for the method of weighting chosen. Indicators were on the whole obtained from routine data sources. Only four of the indexes addressed the problem of validity. A population-based health index is potentially a very useful tool for monitoring the health of a community. More research is needed to determine which health indicators should be used in the formation of such an index and the most appropriate method to combine them.