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Health Indicator Ranking Results
Healthy Reefs for Healthy People
Health Issue Health questions Indicator Type Spatial Criteria I Criteria II Criteria III Criteria IV Criteria V Comments
Pressure State Response National Regional Local  Relevance to the MAR Data Availability Scientific Soundness Management responsiveness Transparency and Understandability
1. Health Is expectancy of life changing? Life expectancy   x   x x x N/A High Moderate N/A Low These indicators are overall indicators of health and indicative of genetics, public health, health care, diet, environmental exposures, etc.  They are not responsive to acute changes in the environment and will not reflect improvements or deteriorations. 
Females Surviving to 65 years of age   x   x x   N/A High Moderate N/A N/A
Males Surviving to 65 years of age   x   x x   N/A High Moderate N/A N/A
What is the overall health of the children and their mothers? Under 5 mortality rate  - Number of deaths in children under 5 years/1000 live births   x   x x x Low High Moderate Moderate Moderate  This indicator is a good summative indicator of health within a population.  It depends on many factors including genetics, nutrition, maternal-natal care, environmental influences, etc. It can also reflect changes occurring in a population over 5-10 years.
Infant (<1 yr) mortality   x   x x x Low High Moderate Moderate Moderate These are measurements of  public health measures in place, primary care and overall health of the mother.  They would reflect major changes in health status that could relate to the MAR over at least 5 years of measurement.  
Maternal mortality ratio adjusted   x   x x x Low High Moderate Moderate Moderate
Infants with low birth weight (%) The percentage of infants with a birth weight of less than 2,500 grams.   x   x x x Low High Moderate Low Moderate
2. Nutrition  Do people have access to sufficient nutrition based on existing resources? Underweight adults/children: median weight for age   x         Moderate Low Moderate Moderate High These indicators are all nutritional indicators.  The most sensitive is probably that of children being underweight since percent changes in weight in children tend to be much greater than in adults due to growth and disease demands.
Prevalence of Undernourishment   x   x x   Moderate High Moderate Moderate High
Percentage of Children under 5 who are underweight   x   x x   Moderate High Moderate Moderate High
Number of people identified as having protein malnutrition   x         Moderate Low Moderate Moderate High
What is the importance of fishing in the diet of the people? Annual food supply per capita from fish and fishery products (kg):   x x x     High Low Moderate High Low These indicators reflect the supply of fish in the area, the intensity of harvesting and potentially the restriction of harvesting.
Fish protein as a percentage of total protein supply (%)   x x x     High Low Moderate High Low
Is a change in diet having a deleterious effect on the health of the population? Prevalence of Diabetes   x   x x   Low High Moderate Moderate High Changing the diet from a predominantly protein (fish-based diet to a predominantly carbohydrate diet may lead to increased numbers of diabetes.  This is also a measurement of disease.
3. Disease: Infections What is the status of infectious diseases within the community? Number of people living with HIV   x   x x x Low High Moderate Low Moderate The incubation of HIV is so long that any change resulting from changes in the MAR will take decades to occur.  There are also so many other confounding variables that contribute to HIV perseverance.
Number of new cases of Pertussus   x   x     N/A Low Low Low N/A Not enough cases to show a difference - relates to both immunization and epidemics.
Annual Number of Malaria Cases   x   x x x Low High High Moderate Moderate An increase in malaria can potentially be caused by shoreline restoration, and return of mosquito infested marshlands.
Malarial Parasitic Incidence per 1000 people   x   x x x Low High High Moderate Moderate
Tuberculosis - Number of new smears showing AFB/100,000   x   x x x Low High High Low Low It is important that total numbers of incidence be determined, but also regional distribution to determine if there is predominantly a coastal predilection to the disease or whether it is homogenous.
Ingestions of man-made contaminants: Is the water causing disease? Incidence of Hepatitis A/ Prevalence of Hepatitis A positive serology   x         Moderate N/A Moderate Moderate Low Information on this is probably not available.  Most cases of Hepatitis A in nutritionally replete individuals are subclinical.  Symptomatic disease is much more likely in malnourished people. 
Incidence of Dysentery – defined as acute bloody diarrhea   x         Low Moderate Moderate Low Moderate These are classic disease indicators and measure the prevalence of key diseases that occur throughout the world.  These indicators reflect public health measures, public hygiene, availability of health care and drugs
Incidence of bacterial toxin-induced illnesses – e.g. ciguatera poisoning   x       x High Low Low Moderate High
Ingestions of man-made contaminants: What is the load of contaminants in the people of the area? Mercury levels   x         Moderate Low Moderate Moderate Moderate There are small regional studies usually related to concern as to point sources.  There have not been large scale assessments to my knowledge in the region.  These indicators reflect poor air, food and water quality as far as presence of man made pollutants.
PCB’s, chlorinated organics (e.g. exposure to POPs and heavy metals through fish consumption (micrograms/gram dry weight)   x         Moderate Low Moderate Moderate Low
Concentration of contaminants in breast milk   x         High High Low High High
4. Health Care How well is health care financed in the region?  Is there money available?  (Of the money available, how much is allocated to health care) % of GDP spent on Health Care   x   x     N/A High Moderate N/A Low These indicators are useful in comparing more developed countries in which the priority on health care is measured.  They have little applicability to the MAR region.
Health Care per capita spending   x   x     Low High Moderate N/A Low
Number of physicians, nurses per capita   x   x x   N/A High Moderate N/A Low
Hospital Beds   x   x x   N/A High Moderate N/A N/A
Outpatient Care Visits per 1000   x   x x x Low High Moderate Moderate Low
Number/distribution of primary care facilities   x   x x x N/A Moderate Moderate N/A Low
Public $ spent on primary care   x x x x   Low Moderate Moderate Low Moderate
Private $ spent on health care   x   x x   N/A Moderate Moderate N/A N/A
Population with sustainable access to affordable essential drugs (%)     x   x x   N/A Moderate Moderate N/A Moderate
5. Public Health Infrastructure, both traditional and western  Is access to proper water and sanitation equitable and improving? Access to improved water source   x x x x x Moderate High High Moderate Moderate These indicators reflect the need for purified water, the economy of the country and the priorities of the country for fresh water.  Frequently, improved water and sanitation are provided through NGO's or foreign governments
Access to sanitation % rural     x x x x x Moderate High High Moderate Moderate
Population with sustainable access to improved sanitation (%)    x x x x x Moderate High High Moderate Moderate
How available is basic public health measures (immunizations, clinics) to the population? Measles Immunization   x   x x x N/A High High Low Moderate These indicators measure basic public health measures for primary and secondary prevention strategies.  They reflect the money available for such strategies, the priority of the government of carry out the strategies and the acceptance of the strategies by the public.
One-year-olds fully immunized against Tuberculosis.    x   x x x N/A High High N/A Moderate
Births Attended by Skilled Personnel   x   x x x N/A Moderate Moderate N/A Moderate
# health clinics/capita   x   x x   N/A Moderate Low Low Moderate
Availability of Health Services to the Public (e.g. are they affordable) (% population using health services).   x x x     N/A Low Moderate N/A Moderate
6. Psychological/ mental health care What is the level of social stress in the community? Substance abuse –(% of population affected by substance abuse)   x   x x   Moderate Low Moderate Low High These indicators reflect many sociological issues including poverty, inequity, and loss of cultural practice/safeguards/ identity.
Suicides per capita   x   x x x Moderate Moderate Moderate Low High
Homicides per capita   x   x x x Low Moderate Moderate Low High
Admissions to mental care facilities (can be too high or too low)   x   x x   Low Low Low Low Moderate
7. Occupational Health Is working dangerous to the individual? Number of work related injuries/deaths   x         Low Low Low Moderate Moderate These indicators require careful governmental monitoring. They are useful in populations in which there is a large proportion of  the people employed in large corporations rather than in small or individual workplaces (e.g. - fishing, farming)
$ spent on workplace safety   x         Low Moderate Moderate Low Moderate
Ranking results are adapted from: Maffi et al., draft report for World Bank (2004).