Executive Summary

Healthy People is the nation's agenda for health promotion and disease prevention. The concept, first established in 1979 in a report prepared by the Office of the Surgeon General, has since been revised on a regular basis, and the fourth iteration, known as Healthy People 2010, will take the nation into the 21st century. The Healthy People agenda, the implementation of which is assigned to the U.S. Department of Health and Human Services (DHHS), has grown over the past 20 years from 15 strategies supporting five primary health goals to approximately 1,000 objectives related to two visionary goals and four enabling goals.

Through regular reporting on progress toward meeting these objectives, it is clear that some aspects of the nation's health are improving, whereas others are not. Healthy People has historically been the domain of one major player among the myriad groups that seek to improve the health of the nation, particularly the federal and state and local public health community. To make further strides, other constituencies need to embrace the notion that monitoring the nation's health is an important component of improving the nation's health. One strategy used to engage these groups and complement the Healthy People compendium of hundreds of specific objectives, each with an associated target outcome, is the development and promotion of a much smaller set of indicators representative of the larger set of Healthy People 2010 goals and objectives.

DHHS requested that the Institute of Medicine (IOM) convene a committee of experts to participate in a three-phase project to develop a set of leading health indicators to complement and expand the Healthy People 2010 program. The first phase of the project is described in this first interim report, which represents the IOM committee's commentary on the audience, functions, criteria, and developmental challenges for the leading health indicators and indicator sets defined in the DHHS publication Leading Indicators for Healthy People 2010: A Report from the HHS Working Group on Sentinel Objectives (U.S. Department of Health and Human Services, 1997b). A second interim report will present and discuss the strengths and weaknesses of potential sets of leading health indicators, with particular focus on those discussed in the Leading Indicators for Healthy People 2010 report. After further study, including a public forum and review of public comments on the first two interim reports, the committee will release a final report with conclusions and recommendations regarding the goals to be achieved from the use of leading health indicators, the criteria by which these goals should be selected, and specific sets of indicators that could be used to determine whether the Healthy People 2010 goals have been achieved.



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--> Executive Summary Healthy People is the nation's agenda for health promotion and disease prevention. The concept, first established in 1979 in a report prepared by the Office of the Surgeon General, has since been revised on a regular basis, and the fourth iteration, known as Healthy People 2010, will take the nation into the 21st century. The Healthy People agenda, the implementation of which is assigned to the U.S. Department of Health and Human Services (DHHS), has grown over the past 20 years from 15 strategies supporting five primary health goals to approximately 1,000 objectives related to two visionary goals and four enabling goals. Through regular reporting on progress toward meeting these objectives, it is clear that some aspects of the nation's health are improving, whereas others are not. Healthy People has historically been the domain of one major player among the myriad groups that seek to improve the health of the nation, particularly the federal and state and local public health community. To make further strides, other constituencies need to embrace the notion that monitoring the nation's health is an important component of improving the nation's health. One strategy used to engage these groups and complement the Healthy People compendium of hundreds of specific objectives, each with an associated target outcome, is the development and promotion of a much smaller set of indicators representative of the larger set of Healthy People 2010 goals and objectives. DHHS requested that the Institute of Medicine (IOM) convene a committee of experts to participate in a three-phase project to develop a set of leading health indicators to complement and expand the Healthy People 2010 program. The first phase of the project is described in this first interim report, which represents the IOM committee's commentary on the audience, functions, criteria, and developmental challenges for the leading health indicators and indicator sets defined in the DHHS publication Leading Indicators for Healthy People 2010: A Report from the HHS Working Group on Sentinel Objectives (U.S. Department of Health and Human Services, 1997b). A second interim report will present and discuss the strengths and weaknesses of potential sets of leading health indicators, with particular focus on those discussed in the Leading Indicators for Healthy People 2010 report. After further study, including a public forum and review of public comments on the first two interim reports, the committee will release a final report with conclusions and recommendations regarding the goals to be achieved from the use of leading health indicators, the criteria by which these goals should be selected, and specific sets of indicators that could be used to determine whether the Healthy People 2010 goals have been achieved.

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--> The stated goals of DHHS of the leading health indicator strategy are (1) the identification of a relatively small set of indicators that will reflect the progress that has been made toward reaching the health goals of the nation and (2) to do so in a manner that expands the reach of the initiative to new audiences such as non-health care professionals, opinion leaders, and the general public. The committee interprets these goals to include a promotion of awareness of the challenges to the nation's health so that the actions of numerous diverse parties can be directed toward improving the health of the population as well as provide the basis for the routine assessment of the results of those actions to increase awareness and promote further action. DHHS defines nine essential criteria for the individual leading health indicators and indicator sets: the general public, opinion leaders, and the health and medical communities can easily interpret and understand the indicators; they reflect topics that affect the health profile of the nation's population in important ways; they address a problem that is sensitive to change and has a substantial impact on prospects for the health of the nation's population; they can be linked to one or more of the full set of Healthy People 2010 objectives; they are generally reliable measures of the state of the nation's health (or that of a subpopulation) to ensure that the problem is reflective of a broadscope perspective for a significant proportion of the population; data on the indicators are available from established sources on a regular (at least biennial) basis; they have multilevel trackability to ensure that data can be anticipated at multiple levels (national, state, local, and community) and for multiple demographic groups; they are reflective of a balance in the selection of targets that does not overemphasize any one group or health condition; they have utility in directing public policy and operational initiatives; The committee believes that these nine criteria are adequate, important, and relevant for the development of a meaningful set of leading health indicators, but in this first interim report it offers suggestions for rewording and expansion of several of the stated criteria. The committee further suggests that the leading health indicators be changeable over a period of time and catalytic in nature to motivate actions across multiple levels of the general population. The committee notes that there are no criteria regarding mechanisms for the dissemination of the leading health indicator sets to the new audiences that it hopes to engage in the Healthy People 2010 program including the general public, communities, businesses, and health professionals outside of the public health community. The committee will expand on its initial review of the criteria and develop specific recommendations, including those for the dissemination of the indicator sets, in the final report. The final report will also include recommendations of two or more sets of indicators for consideration by DHHS and the Secretary of Health and Human Services.