In March, the Institute of Medicine released the draft leading health indicators ( http://www.nap.edu/catalog/13088.html ) with two recommendations. The 12 health indicators were listed under Recommendation 1, and 24 objectives listed under Recommendation 2 for consideration by the U.S. Department of Health and Human Services for guiding a national health agenda:
Recommendation 1:
The Committee recommends that the following indicators be used by HHS as the Healthy People 2020 Leading Health Indicators:
- Proportion of the population with access to health care services
- Proportion of the population engaged in healthy behaviors
- Prevalence and mortality of chronic disease
- Proportion of the population experiencing a healthy physical environment
- Proportion of the population experiencing a healthy social environment
- Proportion of the population that experiences injury
- Proportion of the population experiencing positive mental health
- Proportion of healthy births
- Proportion of the population engaged in responsible sexual behavior
- Proportion of the population engaged in substance abuse
- Proportion of the population using tobacco
- Proportion of the population receiving quality health care services
Process and Background
The Institute of Medicine considered Healthy People 2020’s four overarching goals: (1) Attain high-quality, longer lives free of preventable disease: (2) Achieve health equity; eliminate disparities; (3) Create social and physical environments that promote good health; (4) Promote quality of life, healthy development, and healthy behaviors across life stages. The IOM also took into consideration the four cross-cutting "Foundation Measures." These measures will be used to monitor progress toward promoting health, preventing disease and disability, eliminating disparities, and improving quality of life.
The IOM committee established eight criteria for selecting objectives, and used a conceptual framework that interfaced life course perspective with the health determinants and health outcomes model. The life course approach is based on two concepts: 1) the impact of specific risk factors and determinants of health varies during the life course and 2) health and disease result from the accumulation of the effects of risk factors and determinants over the life course.
The committee also divided into three groups that approached identifying the 24 objectives in three different ways to arrive at the draft 12 indicators and 24 objectives. The Leading Health Indicators are designed to raise public awareness and interest, motivate action by diverse groups, and provide feedback on progress over the decade.
Discussion
In summary, the process used by the IOM committee is very complex and thoughtful. There is broad consensus for the need to identify a finite manageable number of leading health indicators.
Analysis to ensure a balanced approach
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What is especially interesting to read in the report is the different ways the 24 objectives were analyzed to ensure a balanced approach. They were analyzed to answer whether they are representative of the:
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health determinants and health outcomes categories of policy, physical environment, social/economic, health behavior, health and health care services and outcomes to ensure a balanced approached.
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life stages and Healthy People 2020 topics
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components in the federal health reform (this is part of Appendix A)
Consideration before finalizing draft leading health indicators
1. Assessing local availability of data on leading health indicators before finalizing: Before releasing the draft Leading Health Indicators report, the IOM released another thoughtful report, "For the Public’s Health: The Role of Measurement in Action and Accountability." It clearly articulated the need to have data available at the local level to track improvement as that was a major barrier with using Healthy People 2010 leading health indicators. It would be helpful to have seen an analysis of the 24 objectives, data sources, and availability of data at the local level across all states.
2. Hardship Index for Social Determinants of Health but not Leading Health Indicator? The IOM suggested exploring using the use of the Hardship Index for monitoring socioeconomic aspects of the social determinants of health. It is curious why then it was not explored for as a leading health indicator? While education does serve as a proxy for socioeconomic indicator, if there is another option, why not use it?
3. Analysis of policy type in leading health indicator: In December 2009, the Community Health Planning and Policy Development Section submitted comments on draft objectives. One suggestion was to analyze the type of policies: was it downstream, mid-stream or up-stream from the prevention perspective in Healthy People and the Leading Health indicators as the focus for the approach is primary prevention. It would be helpful to conduct such an analysis before finalizing the indicators.
The approval of a final report is expected sometime before the end of the year.
By Priti Irani, MSPH, Immediate Past-Chair and Louise Lex, PhD
Priti Irani works at the New York State Department of Health and Louise Lex works at the Iowa Department of Public Health. The perspectives expressed in this article are those of the authors only, and not of the organizations or the CHPPD Section or that of APHA.
References:
1. Committee on Leading Health Indicators for Healthy People 2020; Institute of Medicine. Leading Health Indicators for Healthy People 2020: Letter Report. (2011). This free PDF is available at http://www.nap.edu/catalog/13088.html
2. Committee on Public Health Strategies to Improve Health; Institute of Medicine. For the Public’s Health: The Role of Measurement in Action and Accountability. (2010) This free PDF is available at http://www.nap.edu/catalog/13005.html
Healthy People 2020 at http://www.HealthyPeople.gov