areas, including one on the Public Health Infrastructure, and 467 objectives for the nation’s health (HHS, 2000). The welter of objectives of varying importance makes it difficult to perceive how much overall progress has been achieved. Recognizing this dilemma, the department has identified 10 high-priority “leading health indicators” that include selected objectives that are being tracked. These leading indicators are physical activity, overweight and obesity, tobacco use, substance abuse, responsible sexual behavior, mental health, injury and violence, environmental quality, immunization, and access to health care.1

All of these indicators represent important health problems, but they are predominantly affected by actions outside the department’s control. The problems either result from individual behavior choices or, as in the case of environmental quality, actions of other federal departments and agencies. The department’s work in these areas may be helpful at the margins, but they are not meaningful indicators of departmental performance.

Additional health goals for the department are identified in its five-year strategic plan, required by GPRA and updated every three years. The 2007–2012 strategic plan, HHS’s most recent, identifies the following four goals, derived from its operational responsibilities in health care, public health, human services, and scientific research and development2:

  • Improve the safety, quality, affordability, and accessibility of health care, including behavioral health care and long-term care.

  • Prevent and control disease, injury, illness, and disability across the lifespan, and protect the public from infectious, occupational, environmental, and terrorist threats.

  • Promote the economic and social well-being of individuals, families, and communities.

  • Advance the scientific and biomedical research and development related to health and human services.


The State of the USA, Inc., in partnership with the National Academies, is developing a web-based system of tracking trends to inform public policy decision making and research, and an IOM committee is participating in that effort by attempting to identify appropriate health indicators to track.


Note that the “public health promotion and protection, disease prevention, and emergency preparedness” goal accounts for 1 percent of the President’s proposed 2009 HHS budget, while the “health care” goal accounts for 93 percent.

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