group undertook a review of examples of sets of current health indicators and focused attention on both theoretical models and criteria essential to those models to develop a substantive set of leading health indicators. A detailed discussion of the work of that group can be found in the publication Leading Indicators for Healthy People 2010: A Report for the HHS Working Group on Sentinel Objectives (U.S. Department of Health and Human Services, 1997b).

DHHS then turned to the Division of Health Promotion and Disease Prevention of IOM to convene a committee to consider the issue of leading indicators and to suggest a minimum of two sets of indicators for consideration by the Secretary of Health and Human Services as the leading health indicators for Healthy People 2010. The remainder of this report focuses on the activities of the committee as it discussed essential functions for potential leading health indicators, considered the strengths and weakness of proposed criteria to substantiate the selection of leading health indicators, and prepared for the future challenges of public comment and review.

Functions of Leading Health Indicators

The development of one or more sets of leading health indicators requires consideration of the functions to be served by the indicators. This issue was addressed only peripherally by the leading health indicators work group and resulted in the recommendation of the nine criteria (see below) that are essential for any individual or set of leading health indicators. To meet the larger goals established for Healthy People 2010, however, it is important to establish broader, interrelated functions for sets of leading indicators: (1) promotion of awareness, (2) motivation to action, and (3) feedback and assessment. These functions establish the cyclical nature of the leading indicators by establishing broad, population-based awareness of the indicator set and its quantitative targets. This awareness, in turn, would foster actions at the community and individual levels. Such actions precipitate a degree of change or movement addressing the cause and effect related to each of the individual leading indicators as well as the set as a whole. The cycle would be complete when the public received assessments in the form of regular and relatively frequent reports to update them on the status of the efforts toward achieving the targets for the leading set of indicators. Such feedback would then precipitate changes or increases in awareness, motivate additional action, and generate additional assessments to modify awareness and actions during the entire course of Healthy People 2010. A more detailed description of each of the functions is provided below.

First, the leading set of indicators should achieve a level of awareness of, attention to, and recognition of leading health issues by the general U.S. population. Such awareness, attention, and recognition can be achieved only through the development, implementation, evaluation, and modification of a comprehensive plan for health communication and the dissemination of information. The importance of generating community and population commitment to the set of leading health indicators cannot be over-emphasized. Previous Healthy People efforts have effectively reached only federal, state, and local health agencies. Successful change in the behaviors of the general population can only be accomplished by inclusion of the general population in the process of change. This will be achieved only if the Healthy People 2010 leading health indicator initiative is supported by effective strategies to initiate, sustain, and maintain community and population involvement in every stage of implementation of the dissemination plan for the leading



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