standings should inform standard setting and education. The recommendations for future work related to summary measures of population health focus on broad directions rather than specific technical issues. The objective is to promote the design of summary measures that are understandable and helpful and to encourage the use of these measures in ways that are accountable and credible. The recommendations are directed primarily at the Department of Health and Human Services, the sponsor of this study.

The Department of Health and Human Services should initiate a process of analysis and public discussion to clarify the ethical assumptions and value judgments embedded in the summary measures and to assess the critical ethical and policy implications of differing designs, implementation approaches, and uses of these measures.

Because controversies about the ethical bases and implications of different measures may so greatly affect the acceptability and application of summary measures in policymaking, those encouraging the use of summary measures and those who would actually use them should have a better understanding of the ethical underpinnings and implications of different measures. Potential users of these measures would then be better informed about the measures’ limitations and less anxious that controversial value judgments may lie buried in obscure, complicated statistical methodologies. As a consequence, they would be better prepared to make choices about whether and how to use summary measures.

To support better understanding of summary measures, the committee suggests several lines of research. One would continue deployment and testing of several different measures, at least for monitoring purposes. Here the goal would be to develop a body of empirical work on the distributive implications of different measures. Such research would highlight the extent to which methodological and value choices embedded in the measure shape the picture presented to decisionmakers.

A second line of research would aim to develop more sensitive and sophisticated techniques for examining public attitudes and reasoning processes related to resource allocations and valued health states. Here it would be crucial to dig beneath the initial preferences people might express to uncover the principles and rationales that guide their moral reasoning about these issues. A related area of investigation would involve a combination of empirical and normative work aimed at clarifying issues of public accountability for specific applications of summary measures in decisionmaking.

A third—and more sweeping—line of investigation would involve further philosophical work on distributive issues. It would seek ways to increase public agreement about distributive policies. Given the divisive potential of such policies and the diversity of philosophic and political positions in the United States, the committee recognizes that such agreement may continue to be elusive.

The Department of Health and Human Services should create a process to establish standards for population health metrics and assess the feasibility and practicality of a compatible set of health status measures that could be used for different descriptive and decisionmaking purposes.



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