LEADING HEALTH INDICATORS FOR HEALTHY PEOPLE 2020

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LEADING HEALTH INDICATORS FOR HEALTHY PEOPLE 2020 LETTER REPORT Committee on Leading Health Indicators for Healthy People 2020 Board on Population Health and Public Health Practice

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THE NATIONAL ACADEMIES PRESS 500 Fifth Street, N.W. Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Gov- erning Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engi - neering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This study was supported by Contract No. HHSP23320042509XI between the National Academy of Sciences and the Department of Health and Human Ser- vices. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project. International Standard Book Number-13: 978-0-309-18637-7 International Standard Book Number-10: 0-309-18637-4 Additional copies of this report are available from the National Academies Press, 500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2011 by the National Academy of Sciences. All rights reserved. Printed in the United States of America The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin. Suggested citation: IOM (Institute of Medicine). 2011. Leading Health Indicators for Healthy People 2020: Letter Report. Washington, DC: The National Academies Press.

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“Knowing is not enough; we must apply. Willing is not enough; we must do.” — Goethe Advising the Nation. Improving Health.

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The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal govern - ment on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its mem - bers, sharing with the National Academy of Sciences the responsibility for advis - ing the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in pro - viding services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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COMMITTEE ON LEADING HEALTH INDICATORS FOR HEALTHY PEOPLE 2020 David Nerenz, Ph.D. (Chair), Director, Center for Health Services Research, Henry Ford Health SystemDetroit, MI Frank Chaloupka, Ph.D., Professor of Economics, Department of Economics, University of Illinois at Chicago Michael Cohen, M.D., Professor and University Chairman Emeritus, Department of Pediatrics, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY Robert Dittus, M.D., M.P.H., Werthan Professor of Medicine, Assistant Vice Chancellor for Public Health, Associate Dean for Population Studies, Director, Institute for Medicine and Public Health, Chief, Division of General Internal Medicine, Vanderbilt University, Nashville, TN Cara James, Ph.D., Director of the Disparities Policy Project, Director of the Barbara Jordan Health Policy Scholars Program, Henry J. Kaiser Family Foundation, Washington, DC Norma Kanarek, Ph.D., M.P.H., Associate Professor, Executive Director of the Maryland Cigarette Restitution Fund at Johns Hopkins Medical Institute, Johns Hopkins University, School of Public Health, Baltimore, MD Vickie Mays, Ph.D., M.S.P.H., Professor of Psychology and Health Services, University of California, Los Angeles Marcia Nielsen, Ph.D., M.P.H., Vice Chancellor for Public Policy and Planning, Associate Professor, Department of Health Policy and Management, University of Kansas Medical Center, Kansas City F. Javier Nieto, M.D., Ph.D., Chair, Department of Population Health Sciences, Professor of Population Health Sciences and Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison Roy Gibson Parrish, M.D., Adjunct Associate Professor, Dartmouth Medical School, Peacham, VT Steven Teutsch, M.D., M.P.H., Chief Science Officer, Los Angeles County Public Health, Los Angeles, CA Scott Young, M.D., Associate Executive Director, Clinical Care and Innovation, Senior Medical Director and Co-Executive, Director, Care Management Institute, Kaiser Permanente, Oakland, CA Project Staff Lyla M. Hernandez, M.P.H., Study Director Andrew Lemerise, Research Associate China Dickerson, Senior Program Assistant v

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Reviewers This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its pub- lished report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report: Bobbie Berkowitz, Ph.D., RN, Dean and Professor, School of Nursing, Columbia University, New York, NY Christine K. Cassel, M.D., President and CEO, American Board of Internal Medicine, Philadelphia, PA Lisa Cooper, M.D., M.P.H., Professor of Medicine, Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD Claude Earl Fox, M.D., M.P.H., Research Professor, University of Miami, Fort Lauderdale, FL Dennis Fryback, Ph.D., Professor Emeritus, Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison Larry A. Green, M.D., Epperson-Zorn Chair for Innovation in Family Medicine, University of Colorado at Denver, Aurora, CO vii

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viii REVIEWERS Lisa Simpson, M.B., B.Ch., M.P.H., President, AcademyHealth, Washington, DC Alan Zaslavsky, Ph.D., M.S., Professor of Health Care Policy, Department of Health Care Policy, Harvard Medical School, Boston, MA Although the reviewers listed above have provided many construc- tive comments and suggestions, they were not asked to endorse the con- clusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by Georges Benjamin, M.D., Executive Director, American Public Health Association and James S. House, Ph.D., Angus Campbell Distinguished University Professor of Survey Research, Institute for Social Research, University of Michigan. Appointed by the National Research Council, they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

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Acknowledgments Over the course of this study, many individuals and organizations were willing to share their expertise, time, and thoughts with the commit- tee. Their contributions informed committee deliberations and enhanced the quality of this report. The study sponsor, the United States Department of Health and Human Services (HHS), willingly provided information and responded to questions. The committee is particularly grateful to Dr. Jeanette Guyton- Krishnan of HHS for her feedback during committee deliberations. The committee greatly appreciates the time and input of speakers Dr. Howard Koh, Dr. Carter Blakey, and Rear Admiral Penny Slade-Sawyer, whose presentations informed committee thinking. The committee was extremely fortunate in its staffing for this study. We wish to thank Lyla M. Hernandez, who did a remarkable job of directing the study. Thanks also go to China Dickerson for her superior administrative support and to Andrew Lemerise for his excellent research support. ix

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Contents HEALTHY PEOPLE 2020 2 RECOMMENDATIONS 3 COMMITTEE PROCESS 5 PRINCIPLES AND PURPOSE 8 FRAMEWORK FOR SELECTING INDICATORS AND OBJECTIVES 9 OBJECTIVES 11 TOPICS AND INDICATORS 17 IMPORTANCE OF OBJECTIVES 23 SUGGESTIONS FOR UNPOPULATED HEALTHY PEOPLE 2020 TOPIC AREAS 43 CONCLUSION 55 REFERENCES 56 APPENDIXES A HEALTH REFORM CROSSWALK: PATIENT PROTECTION AND AFFORDABLE CARE ACT 65 B 24 SELECTED OBJECTIVES WITH SUBOBJECTIVES 77 xi

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Tables and Figures TABLES 1 Topics, Indicators, and Objectives, 6 2 Criteria for Selecting Objectives, 12 3 The Framework Approach to Identifying Topics, Indicators, and Objectives, 18 4 Pollutants and Associated Health Conditions, 28 5 Prevalence of and Mortality Due to Hypertension by Race/Ethnicity and Gender, 33 6 Adults 18 Years and Older Experiencing at Least One MDE in the Past Year by Age, Gender, Marital Status, and Self-Reported Health, 35 7 Past Year Initiation of Tobacco Use Among Persons Aged 12 or Older Who Initiated Use Prior to the Age of 18, by Gender: Numbers in the Thousands, 43 8 Health-Related Quality-of-Life (HRQol) Indices, 50 FIGURES 1 Framework for objectives for leading health indicators, 10 2 Populated framework for objectives for leading health indicators, 15 3 Interrelated pathways through which education affects health, 24 4 Current, binge, and heavy alcohol use among persons 12 or older by age, 2009, 40 xiii

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