Leading Health Indicators for Healthy People 2010: Second Interim Report (1999)

During Spring 1998, the U.S. Department of Health and Human Services (DHHS) contracted with the National Academy of Sciences (NAS), Institute of Medicine (IOM) to conduct a multi phase project resulting in the development of sets of leading health indicators that would provide a ‘face’ for Healthy People 2010. Of equal or greater importance was the development of indicator sets that would attract and sustain public attention and motivation to engage in healthy behaviors. Development of such leading health indicators sets is intended to move the United States toward achievement of more positive health outcomes for the general population and for select population groups defined by race, ethnicity, gender, age, socio-economic status, level of education, and disability.

This second interim report presents a summary of the efforts of the IOM Committee on Leading Health Indicators for Healthy People 2010 to develop sample sets of leading health indicators that would meet the requisite functions of attracting and sustaining attention and motivating engagement in healthier behaviors by the public. Reactions to this report and more specifically, to the potential leading health indicator sets and suggested measures, will be solicited from the public health community as well as representatives of diverse consumer audiences through electronic communication, regional public meetings convened by DHHS, focus group discussions with target populations, and other information-gathering techniques. Review of information from these various sources will be summarized in a third and final report for DHHS to be published in April 1999. The third report will also include the committee's final recommendations regarding the functions to be fulfilled by leading health indicators, will define specific criteria underlying the selection of leading health indicators, and will identify specific sets of leading health indicators to be promoted and monitored during the decade 2000 to 2010.

According to the mandate of DHHS as stated in the 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), acceptable sets of leading health indicators will consist of a relatively small set of indicators reflective of the progress that is made during 2000 to 2010 toward reaching the health objectives of the nation. These indicator sets should effectively communicate with new audiences including, but not limited to, the media, non-health care professionals, faith

groups, voluntary groups, local businesses, community groups, and individuals. Furthermore, leading health indicator sets should engage the public's attention and motivate actions at the individual and community levels that will be consistent with the complete set of Healthy People 2010 objectives. It is of particular importance that the indicator sets address health disparities among select populations defined by race or ethnicity, socio-economic status, gender, age, education level, and disability. The proposed indicator sets should also represent sociodemographic and environmental issues as well as primary, secondary, and tertiary prevention (Nicole Lurie, U.S. Department of Health and Human Services, Personal Communication, 1998). The current availability of data sources to provide annual or biennial information on progress toward targets is of lesser importance since DHHS has expressed a commitment to ensuring the collection of data on each of the leading health indicators within a set selected by the Secretary of Health and Human Services.

The initial report from DHHS, 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) identified 9 criteria considered to be essential for the selection of leading indicators within a set. These were modified in the first interim report of the IOM committee to include (1) plans for effective dissemination of information about the indicator sets, and (2) the ability to motivate desirable behavior changes among the public. Upon further review, the IOM committee identified 4 additional criteria for selection of the leading health indicator sets including:

1. to increase public knowledge and awareness of the indicator sets;
2. encourage members of the general population and select population groups to become participants in the work of health promotion in their local communities;
3. focus the energies of the public and select population groups to ensure that public health outcomes will be improved, and
4. promote leading health indicators that have credibility in, and are supported by the public health community.

This second interim report addresses these additional criteria for the selection of leading health indicators and expands on the DHHS charge to the committee. The committee has engaged in a consensus-building process by which leading health indicator sets that meet the requisite criteria will be developed. Specific actions of this process include (1) development of sample indicator sets, (2) identification of a core set of candidate indicators to be considered in the selection of different groupings or sets of indicators, (3) development of conceptual frameworks to provide structure and focus for leading health indicator sets and ensure integration with the full Healthy People 2010 model, and (4) assessment of sample indicator sets for their ability to reach and motivate the general public and selected population groups as well as their acceptance and support from the public health community. The remainder of this report describes specific activities that have been, or will be, completed to achieve the overriding goal of this consensus-building process—development of a minimum of 2 sets of leading health indicators for submission to the Secretary of Health and Human Services. A final report from the IOM committee will be prepared for April 1999, in which the results of efforts to elicit public feedback and reactions to potential indicator sets are summarized

and a minimum of 2 or more indicators sets will be recommended for consideration by DHHS and the Secretary of Health and Human Services. The presentation of recommended leading health indicator sets in the final report will include discussion of the following issues: (1) congruence with essential criteria; (2) data resources and related issues; (3) sample reactions of the lay public to each recommended indicator set, with particular focus on issues such as appeal, interest, recognition, and ability to motivate positive changes in behaviors and other health determinants; and (4) plans for dissemination to ensure penetration of the indicator sets to members of the public and private health care delivery systems, the media, the general public, and select population groups.