Monitoring children's health and well-being by indicators and index: apples and oranges or fruit salad?

The use of indicators is a fast and widely spread way to monitor groups of children's health and well-being. Indicators are useful in research; but they are also important tools for planners and politicians. Although they are constructed to simplify reality, in many reports they still offer a complex and confusing picture, not least by their sheer numbers. Although they are constructed to simplify reality, in many reports, they still offer a complex and confusing picture, not least by their sheer numbers. Therefore, there is an increasing demand for even further simplifications, where the indicators are combined into single summary numbers, composite indices. At the same time, as a composite index summarizes a complex and sometimes elusive process, making it more accessible for advocacy and political interventions, the combining of very dissimilar components makes the results difficult to interpret and use. There is an obvious dilemma between the need for rigour and evidence, the research orientation, and the wish for a simple and summarizing overview of the findings, the policy orientation. Models have been created to form indicator sets, either by combining them by simple addition or by weighting them or by just leaving them as separate indicators. Most index systems in operation use an equal weighting system after standardization, once the components have been selected. Examples of these models are described as well as their pros and cons, and a summary of suitable ways of handling the problems of indicators and composite indices is offered. Some surveys have taken the best from different approaches, presenting the results as a summary index for the great picture, as subindices for the various domains of child health and as separate indicators for the detailed study of the basic components. A Swedish Child Health Index is presented as an example of such a solution.