The committee also recognizes that efforts to encourage the adoption of a single summary measure of population health have both pluses and minuses. The pluses are comparability in different analyses and greater simplicity in educating users in the interpretation of the measures. The minuses are the risk of adopting a single measure that is ill-suited for some purposes and, possibly, the premature adoption of a measure without a solid understanding of its practical and ethical implications compared to other measures whose development may be truncated. Thus, the committee agrees with the workshop participants that “side-by-side” comparisons of different measures are essential. for movement toward adoption of a standard, comparable set of measures. Such comparisons should identify when and why measures produce different depictions of health when applied simultaneously to the same populations using broadly collected data.
The Department of Health and Human Services should cooperate with other public and private organizations to educate and train public health, medical, and other relevant professionals to promote their understanding of the interpretation and appropriate use of summary measures of population health.
This recommendation is directed primarily at public health professionals and clinicians but also be extends to policymakers, health plan managers, and others. Public health professionals have traditionally focused on population health, but clinicians are increasingly participating in managed care plans and large medical groups that are being held responsible for the health of populations and not just for taking care of individual patients. To reach clinicians—and benefit from their special understanding of patients and their health problems—educational efforts must involve the professional organizations to which practitioners look for guidance. Such efforts can build on existing activities such as the medicine and public health initiative in which the American Medical Association and the American Public Health Association are collaborating.
To conclude, the committee believes that summary measures of health status can make important contributions to decisions about improving population health and well-being. To fully and successfully realize these contributions, continued work is needed to refine these measures and to compare the pictures of health status that they generate. It is likewise important to examine—empirically and normatively—how the use of summary measures and the differences among measures can shape, improve, or distort policy decisions. No measure will be perfect or complete for all purposes, so policymakers have to be aware of the limitations of different measures for different uses. They will continue to need many types and levels of information about individual and population health.
Moving toward better summary measures will involve difficult work along many fronts including ethical analysis, measurement of individual and social preferences, and data collection. It will also require funding from national governments and international organizations and cooperation among agencies and investigators who are sometimes competitors. A variety of initiatives, including activities described in this report, provide encouraging evidence of such support and collaboration to improve summary measures of population health.