nities 2000: Model Standards (APHA et al., 1991) is designed specifically to assist this process. In addition, agencies and organizations with an interest in a specific health issue or a specific population group have made use of particular subsets of the Healthy People 2000 objectives (e.g., American College Health Association, 1990; MCHB, 1991).

Some federal block grant programs (e.g., in prevention and public health services, maternal and child health, and substance abuse) have reporting requirements for states that include health status and outcomes measures, often drawn from or similar to those in Healthy People 2000. Proposals by the U.S. Department of Health and Human Services for Public Health Performance Partnership Grants would require new reporting measures that are intended to focus on the link between grant-supported activities and health outcomes (USDHHS, no date). In general, however, health status assessments have provided baseline information about community health needs but have not explicitly addressed the performance of specific entities in the community, which raises different measurement and community action issues.

Accountability for Efficient and Effective Action

Performance monitoring is also a response to concerns about ensuring the efficient and effective use of resources, particularly financial resources. Overall, higher levels of health care spending in the United States than in most other countries have not produced higher levels of health, measured in terms such as life expectancy or infant mortality. Both public- and private-sector decision makers see a need to use limited funds in ways that optimize health outcomes. This concern is consistent with a heightened interest in accountability for the use of those funds and the outcomes produced.

There is a need to account for performance and outcomes within individual organizations (e.g., a health department or a health plan), but from the committee's perspective, there must also be a way to monitor performance and outcomes for communities as a whole. Looking at the results of many separate efforts will not provide a comprehensive community picture, and those separate efforts cannot, by themselves, ensure that health improvement achieves its goals.

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