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

Indicator set A is relatively simple both in number of indicator categories and in number of suggested measures. It focuses on 3 primary health areas: health and disease outcomes, protective health behaviors, and access to health care. Health determinants associated with ecological or social factors are not considered by this model. The focus is on selection of indicator categories and possible measures that would have almost immediate recognition with the general population and select population groups and have existing data sets from which information can be collected on a routine basis. Sources such as Vital Statistics, Surveillance, Epidemiologic, and End Results Registries, National Health Interview Survey, Youth Behavioral Risk Factor Survey, and the Behavioral Risk Factor Surveillance Survey would be key data contributors. At this point, the sample indicator set does not address the issue of relative weights of indicators and their suggested measures. Rather, it proposes each indicator and measure as separate and equal assessments of the health of the nation's population and select population groups. Its inclusion of references to select population groups within each measure ensures that the significance of the Year 2010 Vision of eliminating health disparities will be maintained. Finally, Table A, displaying congruence between indicators and essential criteria is included in Appendix A.

Indicator Category: Health and Disease Outcomes

Suggested Measures

1. Self-reported health status of general population and select population groups
2. Number of days of depression and/or anxiety in past 30 days experienced by general and select population groups with activity limitations who need assistance
3. Days of school or work lost due to activity limitations for the general population and select population groups
4. Number of days in past 30 when general population and select population groups with activity limitations and in need of assistance feel healthy

5. Age-specific and age-adjusted all-cause mortality rates for individuals age 21 or younger in the general population and select population groups
6. All-cause infant mortality rates for general population and select population groups
7. Age-specific and age-adjusted mortality rates attributable to cardiovascular disease in the general population and select population groups
8. Age-specific and age-adjusted mortality rates attributable to all cancers in the general population and select population groups
9. Age-specific and age-adjusted mortality rates attributable to breast cancer in the general population and select population groups
10. Age-specific and age-adjusted mortality rates attributable to cervical cancer in the general population and select population groups
11. Age-specific and age-adjusted mortality rates attributable to colorectal cancer in the general population and select population groups
12. Age-specific and age-adjusted mortality rates attributable to prostate cancer in the general population and select population groups
13. Age-specific and age-adjusted mortality rates attributable to lung cancer in the general population and select population groups
14. Age-specific and age-adjusted mortality rates attributable to HIV in the general population and select population groups
15. Age-adjusted and age-specific incidence rates for diagnosed AIDS cases among general and select population groups
16. Incidence rates for low birth weight and very low birth weight in the general population and select population groups
17. Age-adjusted and age-specific suicide rates for general population and select population groups

Indicator Category: Preventive Health Behaviors

Suggested Measures

1. Percent of young people (grades 9 to 12) in general and select population groups who have used tobacco products
2. Percent of adults 18 years and older in general and select population groups who have used tobacco products
3. Percent of young people (grades 9 to 12) in general and select population groups who participate in physical education program at school on a daily basis
4. Percent of adults 18 years and older in general and select population groups who engage regularly, preferably daily, in sustained physical activity for at least 30 minutes per day
5. Percent of adults 18 years and older in general and select population groups who engage in vigorous physical activity that promotes the development and maintenance of cardiorespiratory fitness for 3 or more days per week for 20 minutes per session

6. Percent of all pregnancies among women aged 15 to 44 that are planned
7. Percent of all females aged 15 to 44 at risk of unintended pregnancy who use effective contraception

Indicator Category: Access to Health Care System

Suggested Measures

1. Percent of general and select population groups without health care coverage
2. Percent of general and select population groups with specific source of ongoing primary care services
3. Percent of population and select population groups living within 60 miles of primary health care facility
4. Percent of general and select population groups who have coverage for clinical preventive services as part of their health insurance

Indicator Set B attempts to be all inclusive in nature by referencing all plausible factors that might directly impact or mediate health and health outcomes. It consists of 8 indicator categories with multiple measures suggested for each of the specific categories. Congruence between these 8 indicators and the 14 essential criteria are displayed in Table B, Appendix B. The measures rely heavily on epidemiological constructs and would require extensive reworking to ensure that they are meaningful to the general public and select population groups. Currently the total number of suggested measures is quite expansive and will require significant reduction in order for the set to be effective as a leading health indicator set that elicits public interest and motivates public actions. As with Indicator Set A and the remaining 4 Indicator Sets described below, there are specific references to both the general population and select population groups in order to emphasize the importance of elimination of health disparities. Similar to the other sample indicator sets, Set B does not impose relative weights of significance or importance on specific indicators or measures at this time, although it is likely that relative weights would be assigned if the set were to test well with the public and be included as a recommended leading health indicator set in the final report.

Indicator Category: Preventable Death

Suggested Measures

1. All-cause mortality rates age-adjusted and age-specific for general and select population groups
2. All-cause infant mortality rates for general and select population groups
3. Age-adjusted and age-specific mortality rates attributable to cardiovascular disease in general and select population groups
4. Age-adjusted and age-specific mortality rates attributable to all cancers for general and select population groups
5. Age-specific and age-adjusted mortality rates attributable to breast cancer in the general population and select population groups
6. Age-specific and age-adjusted mortality rates attributable to cervical cancer in the general population and select population groups
7. Age-specific and age-adjusted mortality rates attributable to colorectal cancer in the general population and select population groups
8. Age-specific and age-adjusted mortality rates attributable to lung cancer in the general population and select population groups
9. Age-specific and age-adjusted mortality rates attributable to prostate cancer in the general population and select population groups
10. Age-adjusted and age-specific mortality rates attributable to diabetes for general and select population groups
11. Age-specific and age-adjusted incidence rates for diagnosed AIDS cases among the general population and select population groups
12. Age-specific and age-adjusted mortality rates attributable to AIDS in the general population and select population groups
13. Age-specific and age-adjusted suicide rates for the general population and select population groups

Indicator Category: Preventable Morbidity

Suggested Measures

1. Incidence rates for pregnancies among females 15 to 17 years old in the general population group and specific population groups
2. Percent of women aged 15 to 44 years old in general population and special population groups who experience pregnancy despite use of a reversible contraceptive method
3. Number of chlamydia trachomatis infections among young persons 15 to 24 years old
4. Age-specific and age-adjusted incidence rates for gonorrhea for general and select population groups

5. Age-specific and age-adjusted incidence rates for diagnosed AIDS cases among the general population and select population groups
6. Age-specific and age-adjusted incidence rates for low birth weight and very low birth weight infants among the general and select population groups
7. Age-specific and age-adjusted incidence rates for preterm births in general population and select population groups
8. Age-specific and age-adjusted incidence rates for iatrogenic disease for general and select population groups

Indicator Category: Disabilities

Suggested Measures

1. Life expectancy at birth and at different ages of life (years of life lost) for general and select population groups
2. Years of healthy life for general and select population groups
3. Days of school or work lost due to activity limitations for general and select population groups
4. Percent of population able to perform usual activities of daily living for general and select population groups
5. Number of days in past 30 when general population and special population groups with activity limitations who need assistance felt healthy

Indicator Category: Mental Health

Suggested Measures

1. Percent of general and select population groups diagnosed with mental disorders
2. Percent of general and select population groups who have limitations due to mental or emotional problems who received services for their problems
3. Age-adjusted and age-specific suicide rates for general and select population groups
4. Percent of older adults (65 years and older) in general and select population groups diagnosed with depression who received services for their problems
5. Percent of children and adolescents who are diagnosed with mental and emotional problems who received services for their problems

Indicator Category: Health Status

Suggested Measure

1. Percent of general population and select population groups rating health as good or better

Indicator Category: Ecological

Suggested Measures

1. Age-specific and age-adjusted homicide rates for general population and select population groups
2. Age-specific and age-adjusted mortality and morbidity rates attributable to unintentional injuries for general population and select population groups
3. Age-specific and age-adjusted mortality and morbidity rates attributable to motor vehicle accidents for general population and select population groups
4. Age-specific and age-adjusted mortality and morbidity rates attributable to firearms for general population and select population groups
5. Age-specific and age-adjusted incidence of pedestrian injuries for general population and select population groups
6. Percent of general population and select population groups experiencing personal crime or physical violence
7. Prevalence of use of safety belts and child restraints among the general population and specific population groups
8. Age-specific and age-adjusted mortality and morbidity rates attributable to residential fires for general population and select population groups

Indicator Category: Preventive Health Behaviors

Suggested Measures

1. Incidence of pregnancies among females 15 to 17 years old in the general population and select population groups
2. Percent of all females aged 15 to 44 at risk of unintended pregnancy who use effective contraception in the general population and select population groups
3. Percent of young people (grades 9 to 12) in general and select population groups who have used tobacco products
4. Percent of adults 18 years and older in general and select population groups who have used tobacco products

5. Age-specific and age-adjusted morbidity rates attributable to alcohol-related motor vehicle accidents in the general population and select population groups
6. Age-specific and age-adjusted mortality rates attributable to alcohol-related motor vehicle accidents in the general population and select population groups
7. Percent of high school seniors in the general population and select population groups reporting they have never used alcohol or any illicit drug
8. Average age of first use of alcohol and marijuana by adolescents aged 12 to 17 years in the general population and select population groups
9. Percent of youth aged 12 to 17 years in general and select population groups reporting use of alcohol during the past 30 days
10. Percent of youth aged 12 to 17 years in general and select population groups reporting use of marijuana during the past 30 days
11. Percent of youth aged 12 to 17 years in general and select population groups reporting use of illicit drugs during the past 30 days
12. Percent of children and adolescents 2 to 17 years old in general and select population groups who are at medically recommended weight levels
13. Percent of adults 18 years and older in the general population and select population groups who are at medically recommended weight levels
14. Percent of people aged 2 years and older in the general population and select population groups who report eating 5 or more servings of fruits and vegetables per day
15. Percent of people aged 2 years and older in the general population and select population groups who report eating at least 6 servings of grain products per day
16. Percent of young people (grades 9 to 12) in the general and select population groups who participate in physical education programs at school on a daily basis
17. Percent of adults 18 years and older in the general population and select population groups who engage in regular, preferably daily, sustained physical activity for at least 30 minutes per day
18. Percent of adults 18 years and older in the general population and select population groups who engage in vigorous physical activity that promotes the development and maintenance of cardiorespiratory fitness for 3 or more days per week for 20 minutes per session
19. Percent of infants in the general population and select population groups receiving all recommended immunizations by 19 to 35 months
20. Percent of adults 18 years and older in the general population and select population groups receiving age-appropriate immunization coverage
21. Percent of women 50 years and older in the general population and select population groups who have had a mammogram in the past year
22. Percent of sexually active women in the general population and select population groups who have had a Pap test in the past 3 years
23. Percent of adults 50 years and older in the general and select population groups who have had a flexible sigmoidoscopic exam in the past 1 to 5 years
24. Percent of adults 18 years and older in the general population and select population groups who have had blood pressure checked in preceding 2 years and can state whether their blood pressure was normal or high

25. Percent of adults 18 years and older in the general population and select population groups who have had their blood cholesterol level checked within the past 5 years and can state whether their cholesterol was acceptable or high

Indicator Category: Access to Health Care

Suggested Measures

1. Percent of general population and select population groups without health care coverage
2. Percent of general population and select population groups who have coverage for clinical preventive services as part of their health insurance
3. Percent of general population and select population groups with specific source of ongoing primary care services
4. Percent of general population and select population groups living within 60 miles of primary care health facility
5. Average dollar amount spent on health care per individual in past year for the general population and select population groups
6. Proportion of annual health dollars spent on primary, secondary, tertiary prevention, technology development and research

This is a relatively simple model with a primary emphasis on ecological factors that affect health and health outcomes. Rather than measuring specific health behaviors or dimensions, it assesses factors or policies that are likely to mediate these health behaviors. It consists of only nine indicators, which could facilitate dissemination to the general population and select population groups. This advantage however, is offset by the likelihood that these specific measures may not be readily recognizable by, or understandable to various population groups, which may undermine their ability to motivate personal action. Furthermore, the indicators and suggested measures are not directed toward individual behaviors that might be susceptible to change. Consequently, it may be difficult to develop a dissemination plan for this sample indicator set that effectively engages the public. Appendix C contains the table displaying congruence between indicators and the 14 essential criteria. This model does address the important topic of health disparities by referencing both the general population and select population groups as measurement targets.

Indicator Category: Education Level

Suggested Measure

1. Percent of students in general population and select population groups graduating from high school

Indicator Category: Air Quality

Suggested Measure

1. Percent of general population and select population groups living in counties that do not meet air quality standards

Indicator Category: Fiscal Access

Suggested Measures

1. Percent of children in general population and select population groups living in families/households with incomes below the federal poverty level
2. Percent of general population and select population groups living in households with incomes below the federal poverty level

Indicator Category: Health Literacy

Suggested Measure

1. Percent of health education materials written at sixth-grade level that are culturally and language-appropriate

Indicator Category: Homelessness

Suggested Measure

1. Percent of the general population and select population groups who are homeless (including those living in shelters for the homeless)

Indicator Category: Violence

Suggested Measure

1. Percent of general population and select population groups reporting that they feel it is safe to walk unattended in their community at night

Indicator Category: Tobacco

Suggested Measures

1. Average excise tax on tobacco products
2. Average rate at which minors in general population and select population groups are able to purchase tobacco products as indicated from compliance checks

Indicator Category: Injury

Suggested Measure

1. Percent of general population and select population groups living in communities that require helmets to be worn when riding a bicycle and motorcycle

Indicator Set D is expressed as a series of 4 questions. (1) how do we keep ourselves well; (2) if we are getting sick, how can we find disease early; (3) if we are sick or disabled, how do we keep from getting worse; and (4) how healthy are we? The use of 4 simple questions is appealing in that they speak directly to issues that the general public and select population groups will likely comprehend. Each question is followed by a series of health indicators and potential measures that suggest individual or community-based action in order to improve the nation's answers to each of the 4 questions. Congruence between the indicators and the 14 essential criteria is displayed in Table D, Appendix D. The indicators are not weighted in any manner at present, although this would be necessary for this set to be accepted as a recommended leading health indicator set for the final report. Furthermore, at this stage of development, the set consists of too many suggested measures, but, as with Indicator Set B, these can be reduced. The issue of elimination of health disparities is handled effectively by this framework as it is in the other sets with reference to the general population and select population groups for each of the suggested measures. This framework lends

itself easily to the development of a dissemination plan based on the 4 primary or leading health questions.

Indicator Category: Primary Prevention

Suggested Measures

1. Percent of infants in the general population and select population groups receiving all recommended immunizations by 19 to 35 months
2. Percent of adults 18 years and older in the general population and select population groups receiving age-appropriate immunization coverage
3. Percent of young people (grades 9 to 12) in general and select population groups who report having used tobacco products
4. Percent of adults 18 years and older in general and select population groups who report having used tobacco products
5. Percent of general population and select population groups who are living in counties with acceptable air quality greater than 75 percent of the time
6. Percent reduction in emissions due to increases in number of trips made by bicycling, walking, mass transit and telecommuting among the general population and select population groups
7. Percent of young people (grades 9 to 12) who participate in a physical education program at school on a daily basis
8. Percent of adults 18 years and older in the general population and select populations who engage regularly, preferably daily, in sustained physical activity for at least 30 minutes per day
9. Percent of adults 18 years and older who engage in vigorous physical activity that promotes the development and maintenance of cardiorespiratory fitness for 3 or more days per week for 20 minutes per session
10. Percent of high school seniors in general and select population groups reporting they have never used alcoholic beverages or any illicit drug
11. Percent of adolescents aged 12 to 17 in general and select population groups reporting use of alcohol during the past 30 days
12. Percent of adolescents aged 12 to 17 in general and select population groups reporting use of marijuana during the past 30 days
13. Percent of adolescents aged 12 to 17 in general and select population groups reporting use of illicit drugs during the past 30 days
14. Age-adjusted and age-specific morbidity rates attributable to alcohol-related motor vehicle accidents in the general population groups
15. Age-adjusted and age-specific morbidity rates attributable to alcohol-related motor vehicle accidents in the general population groups

16. Percent of adolescents and young adults aged 12 to 24 in the general population and select populations who remain alcohol and drug-free
17. Percent of children in the general population and select population groups living in families/households with incomes below the federal poverty level
18. Percent of the general population and select population groups living in households with incomes below federal poverty level
19. Percent of health education materials written at 6th grade level that are culturally and language-appropriate
20. Percent of children and adolescents ages 2 to 17 in general and select population groups who are at medically recommended weight levels
21. Percent of adults 18 years and older in the general population and select population groups who are at medically recommended weight levels
22. Percent of people aged 2 years and older in the general population and select population groups who report eating 5 or more servings of fruits and vegetables per day
23. Percent of people aged 2 years and older in the general population and select population groups who report eating at least 6 servings of grain product per day
24. Percent of students in the general population and select population groups completing high school
25. Percent of general population and select population groups experiencing personal crime or physical violence
26. Percent of the general population and select population groups who are homeless (including those living in homeless shelters for the homeless)

Indicator Category: Secondary Prevention

Suggested Measures

1. Percent of general population and select population groups with specific source of ongoing health care services
2. Percentage of general population and select population groups living within 100 miles of a tertiary care center
3. Proportion of health dollars spent on general population and select population groups for secondary prevention
4. Percent of women 50 years and older in the general population and select population groups who have had a mammogram in the past year
5. Percent of sexually active women in the general population and select population groups who have had a Pap test in the past 3 years
6. Percent of adults 50 years and older in general and select population groups who have had a flexible sigmoidoscopic exam in the past 1 to 5 years

7. Percent of adult males 50 years and older in the general population and select population groups who have had a DRE and prostate-specific antigen test in the past year
8. Percent of persons in the general population and select population groups with diabetes whose condition has been diagnosed

Indicator Category: Tertiary Care

Suggested Measures

1. Percent of general population and select population groups having a regular source of health care coverage
2. Percent of general population and select population groups living within 100 miles of a tertiary care center
3. Proportion of total health dollars spent on general population and select population groups for tertiary care
4. Percent of general population and select population groups with access to state-of-the-science medical interventions for all cancers
5. Percent of general population and select population groups with access to state-of-the-science medical interventions for asthma or chronic obstructive pulmonary disease
6. Age-specific and age-adjusted incidence rates among general population and select population groups for iatrogenic illness
7. Percent of general population and select population groups with access to state-of-the-science medical interventions for diabetic complications
8. Percent of general population and select population groups with access to state-of-the-science medical interventions for cardiovascular disease

Indicator Category: Health Status

Suggested Measures

1. Percent of all pregnancies among women aged 15 to 44 in the general population and select population groups that are planned
2. Percent of all females aged 15 to 44 among the general population and select population groups at risk for unintended pregnancy who use effective contraceptives
3. Percent of general population and select population groups able to perform usual activities of daily living

4. All-cause infant mortality rates for the general population and select population groups
5. Age-adjusted and age-specific all cause mortality rates for the general population and select population groups
6. Age-adjusted and age-specific mortality rates attributable to cardiovascular disease in the general population and select population groups
7. Age-adjusted and age-specific mortality rates attributable to all cancers in the general population and select population groups
8. Age-adjusted and age-specific mortality rates attributable to specific cancers in the general population and select population groups
9. Age-adjusted and age-specific mortality rates attributable to diabetes in the general population and select population groups
10. Number of days of school or work lost due to activity limitations among the general population and select population groups
11. Years of healthy life for the general population and select population groups
12. Percent of the general population and select population groups rating their health as good or better
13. Number of cases of diagnosed chlamydia trachomatis infections among young persons 15 to 24 years old in the general population and select population groups
14. Age-specific and age-adjusted incidence rates attributable to gonorrhea in the general population and select population groups
15. Age-specific and age-adjusted incidence rates attributable to HIV in the general population and select population groups
16. Incidence of pregnancies among females 15 to 17 years old in the general population and special population groups
17. Incidence rates in the general population and select population groups for low birth weight and very low birth weight infants
18. Percent of general and select population groups who report limitations due to mental or emotional problems
19. Percent of general and select population groups diagnosed with mental illness and receiving treatment
20. Age-specific and age-adjusted suicide rates for general and select population groups
21. Percent of older adults (65 years and older) in general and select population groups diagnosed with depression and receiving treatment
22. Percent of young people aged 12 to 17 in the general population and select population groups reporting the use of illegal substances in past 30 days
23. Age-specific and age-adjusted morbidity rates attributable to motor vehicle accidents for the general population and select population groups
24. Age-specific and age-adjusted mortality rates attributable to motor vehicle accidents for the general population and select population groups
25. Age-specific and age-adjusted mortality rates attributable to firearms for the general population and select population groups

27. Age-specific and age-adjusted morbidity rates attributable to firearms for the general population and select population groups
28. Age-specific and age-adjusted mortality rates attributable to residential fires for the general population and select population groups
29. Age-specific and age-adjusted morbidity rates attributable to residential fires for the general population and select population groups
30. Age-specific and age-adjusted incidence rates for hip fracture among older adults (65 years and older) in general population and select population groups
31. Age-specific and age-adjusted morbidity and mortality rates attributable to complications associated with hip fractures among older adults (65 years and older) in the general population and select population groups
32. Age-specific and age-adjusted morbidity and mortality rates for general population and select population groups who have experienced an unintentional personal injury

This sample indicator set covers all of the issues directly and indirectly associated with health behaviors and outcomes but is somewhat more limited in scope than its counterpart Indicator Set B. It addresses the issue of elimination of health disparities through specification of select population groups and the general population in each of the suggested measures, thereby keeping health disparities a salient and important target. Congruence between the 14 essential criteria and each indicator is displayed in Table E, Appendix E. This indicator set requires reduction of the suggested measures within each indicator category, to ensure that the set is of a reasonable size and content for inclusion as a recommended indicator set in the final report. The various indicator categories within the title of the indicator set form an acronym, POISE, that might elicit public attention and promote engagement in appropriate behaviors. However, the acronym and the full set of indicators require evaluation by the general population and select population groups to determine their effectiveness in engaging and motivating the public. As with the other 5 sample indicator sets, weights have not been assigned either to the indicator categories or to suggested measures, which implies that all are equivalent in their impact on health outcomes. The committee is currently addressing the issue of weighting specific measures for each of the 6 sample indicator sets.

Indicator Category E: Preventive Health Behaviors

Suggested Measures

1. Percent of young people (grades 9 to 12) in general and select population groups who have used tobacco products

2. Percent of adults 18 years and older in general and select population groups who have used tobacco products
3. Percent of young people (grades 9 to 12) in general and select population groups who participate in physical education programs at school on a daily basis
4. Percent of adults, age 18 and older in the general population and select population groups who engage regularly, preferably daily, in sustained physical activity for at least 30 minutes, 5 or more times each week
5. Percent of adolescents (aged 12 to 17 years) in general and select population reporting use of alcohol during the past 30 days
6. Age-specific and age-adjusted morbidity and mortality rates attributable to alcohol-related motor vehicle accidents in general and select population groups
7. Percent of health education materials written at sixth-grade level that are culturally and language-appropriate
8. Percent of children and adolescents (aged 2 to 17) in general and select population groups who are at medically recommended weight levels
9. Percent of adults 18 years and older in the general population and select population groups who are at medically recommended weight levels

Indicator Category: Occupational and Ecological Issues

Suggested Measures

1. Percent of general population and select population groups who are exposed to secondhand smoke in workplace
2. Years of healthy life for general population and select population groups
3. Percent of general population and select population groups able to perform usual activities of daily living
4. Days of school/work lost in general population and select population groups due to disabilities
5. Percent of worksite health and wellness education materials available at the sixth-grade reading level that are culturally and language-appropriate for the general population and select population groups
6. Percent of worksites offering culturally and language-appropriate health education materials at sixth-grade reading level, and interventions relevant to sexually transmitted diseases and HIV to general population and select population groups
7. Percent of general population and select population groups experiencing a work-related injury and receiving appropriate medical intervention
8. Percent of worksites offering the PSA blood test to men 40 years and older in the general population and select population groups
9. Percent of worksites offering mammograms and breast exams to women 40 ears and older in the general population and select population groups

10. Percent of worksites providing insurance coverage for cancer screening exams for the general population and select population groups
11. Percent of worksites offering blood pressure screenings to employees 21 years and older in the general population and select population groups
12. Percent of worksites providing insurance coverage for cardiovascular screening exams for the general population and select population groups
13. Percent of worksites offering cholesterol profile screenings to employees 21 years and older in the general population and select population groups
14. Percent of worksites providing coverage for prenatal care for the general population and select population groups
15. Percent of worksites offering incentives to employees in the general population and select population groups, who are expecting the birth of a child, to complete full prenatal care programs
16. Percent of worksites offering glucose screening for employees 21 years and older in the general population and select population groups
17. Percent of worksites providing insurance coverage for diabetes screening exams in the general population and select population groups
18. Percent of worksites providing insurance coverage for screening for diabetic complications in the general population and select population groups
19. Percent of worksites providing insurance coverage for secondary and tertiary prevention of asthma or chronic obstructive pulmonary disease for the general population and select population groups

Indicator Category: Indicators of Disease Incidence and Outcomes

Suggested Measures

1. All-cause infant mortality rates for the general population and select population groups
2. Age-specific and age-adjusted incidence rates attributable to chlamydia trachomatis among young persons (15 to 24 years olds) in the general population and select population groups
3. Age-specific and age-adjusted incidence rates for gonorrhea among the general population and select population groups
4. Age-specific and age-adjusted incidence rates of diagnosed AIDS cases among the general population and select population groups
5. Percent of women 15 to 44 years old in the general population and select population groups who experience pregnancy despite use of a reversible contraceptive device
6. Percent of women 50 years and older in the general population and select population groups who have had a mammogram in the past year
7. Percent of sexually active women in the general population and select population groups who have had a Pap test in the past 3 years
8. Percent of adults 50 years and older in the general population and select population groups who have had a flexible sigmoidoscopic exam in the past 1 to 5 years

9. Percent of males 50 years and older in the general population and select population groups who have had a DRE and PSA test in the past year
10. Incidence rates for low birth weight and very low birth weight for the general population and select population groups
11. Percent of adults 18 years and older in the general population and select population groups who have had their blood pressure checked in the preceding 2 years and can state whether their blood pressure was normal or high
12. Percent of adults 18 years and older in the general population and select population groups who have had their blood cholesterol checked within the past 5 years and can state whether their cholesterol level was acceptable or high
13. Percent of persons in the general population and select population groups with diabetes whose condition has been diagnosed.

Indicator Category: Service Availability

Suggested Measures

1. Percent of general population and select population groups without health care coverage
2. Percent of general population and select population groups with a usual source of primary health care
3. Percent of general population and select population groups living within 60 miles of a primary care health facility
4. Proportion of total health care expenditures for general population and select population groups allocated to primary, secondary, and tertiary prevention; health research; and health technology
5. Percent of infants in the general population and select population groups who receive all recommended immunizations by 19 to 35 months
6. Percent of adults 18 years and older in the general population and select population groups receiving age-appropriate immunization coverage 7 Age-specific and age-adjusted incidence rates attributable to iatrogenic disease in the general population and select population groups
7. Age-specific and age-adjusted mortality rates attributable to iatrogenic disease in the general population and select population groups

Indicator Category: Environment and Ecological

Suggested Measures

1. Proportion of country that is targeted as no-smoking zones

2. Percent of general population and select population groups who are living in counties with acceptable air quality greater than 75 percent of the time
3. Percent of children in the general population and select population groups living in families households with incomes below the federal poverty level
4. Percent of the general population and select population groups living in households with incomes below the federal poverty level.
5. Age-specific and age-adjusted morbidity rates attributable to motor vehicle accidents among the general population and select population groups injured
6. Age-specific and age-adjusted mortality rates attributable to motor vehicle accidents in the general population and select population groups
7. Age-specific and age-adjusted morbidity rates attributable to firearms among the general population and select population groups
8. Age-specific and age-adjusted mortality rates attributable to firearms in the general population and select population groups in past year
9. Percent of general population and select population groups experiencing personal violence or crime
10. Age-specific and age-adjusted mortality rates attributable to personal violence or crime in the general population and select population groups
11. Age-specific and age-adjusted morbidity rates attributable to unintentional injuries among the general population and select population groups
12. Age-specific and age-adjusted mortality rates attributable to unintentional injuries in the general population and select population groups in past year
13. Percent of the general population and select population groups who are homeless (including those living in shelters for the homeless)

The final sample set of indicators is adapted from Healthy People 2010 in that it uses the four enabling goals to provide a framework around which indicators and suggested measures can be organized. Rather than selecting indicator categories from the master list of candidate indicators (Table 4-1), this organizational structure relies on the four enabling goals to define priority areas for indicators. This model is particularly attractive given its close integration with the Healthy People 2010 effort. However, it is currently constrained by two primary issues—the total number of indicators and measures and its questionable level of recognition by the general public and select population groups. It is highly likely however to elicit support and credibility with the public health community given the direct link with Healthy People 2010. The elimination of health disparities is addressed in the same manner in which the previous five frameworks have dealt with this issues. At this point, the committee has not selected a plan to weight individual indicators and measures, which is essential if the total number of measures and indicators is to be reduced to a reasonable number for a leading health indicator set. Appendix F displays the chart providing an evaluation of congruence between indicators and the 14 essential criteria.

Increase Years of Healthy Life

Suggested Measures

1. Days of school or work lost due to disabilities in the general population and select population groups
2. Percent of the general population and select population groups rating personal health as good or better
3. Percent of general and select population groups diagnosed with mental or emotional disorders
4. Percent of general population and select population groups who have limitations due to emotional or mental problems who received services for their problems
5. Age-adjusted and age-specific suicide rates for the general population and select population groups
6. Percent of older adults (65 years and older) in the general population and select population groups diagnosed with depression who received services for their condition
7. All-cause infant mortality rates for general population and select population groups
8. Age-specific and age-adjusted incidence rates among general population and select population groups attributable to cardiovascular disease
9. Age-specific and age-adjusted morbidity and mortality rates attributable to cardiovascular disease in the general population and select population groups
10. Age-adjusted and age-specific all-cause mortality rates for the general population and select population groups
11. Life expectancy at birth and different ages of life for the general population and select population groups
12. Years of healthy life for the general population and select population groups
13. Days of school or work lost due to disabilities in the general population and select population groups
14. Percent of the general population and select population groups able to perform usual activities of daily living
15. Percent of the general population and select population groups rating health as good or better
16. Incidence rates for pregnancies in females 15 to 17 years old in the among general population and select population groups
17. Age-specific and age-specific incidence rates for chlamydia trachomatis in females 15 to 24 years old in the general population and select population groups
18. Age-specific and age-adjusted incidence rates for gonorrhea among the general population and select population groups
19. Age-specific and age-adjusted incidence rates among the general population and select population groups for diagnosed AIDS cases
20. Age-specific and age-adjusted mortality rates among general population and select population groups for diagnosed AIDS cases
21. Age-specific and age-adjusted incidence rates attributable to hip fractures among the general population and select population groups for hip fractures

Indicator Category: Preventive Health Behaviors

Suggested Measures

1. Percent of young people (grades 9 to 12) in general and select population groups who have used tobacco products
2. Percent of adults 18 years and older in the general and select population groups who have used tobacco products
3. Percent of general population and select population groups living in communities that require helmets to be worn when riding a bicycle or motorcycle
4. Percent of young people (grades 9 to 12) in general and select population groups who participate in physical education programs at school on a daily basis
5. Percent of adults 18 years and older in general population and select population groups who engage in regular, preferably daily sustained physical activity for at least 30 minutes per day
6. Percent of people aged 2 and older in the general population and select population groups who report eating 5 or more servings of fruits and vegetables per day
7. Percent of people aged 2 and older in the general population and select population groups who report eating at least 6 servings of grain products per day
8. Percent of high school seniors in the general population and select population groups reporting they have never used alcohol or any illicit drug
9. Average age of first use of alcohol and marijuana by adolescents aged 12 to 17 years in the general population and select population groups
10. Percent of culturally and language-appropriate health education materials and interventions prepared at the 6th grade reading level and intended for the general population and select population groups
11. Percent of children and adolescents (aged 2 to 17) in general and select population groups who are at medically recommended weight levels
12. Percent of adults 18 years and older in the general population and select population groups who are at medically recommended weight levels

Indicator Category: Protective Health Behavior

Suggested Measures

1. Age-specific and age-adjusted incidence rates attributable to unintentional injury in the general population and select population groups
2. Incidence rates for pregnancy among females 15 to 17 years old in the general population and select population groups
3. Percent of women 15 to 44 years old in the general population and select population groups who experience pregnancy despite use of a reversible contraceptive method

4. Percent of general population and select population groups age 18 or older who have had blood pressure check in past year and can report if it was normal or high
5. Percent of adults 18 years and older in the general who have had their cholesterol checked in the past 5 years and can report if it was acceptable or high
6. Percent of women 50 years and older in the general population and select population groups who have had a mammogram in the past year
7. Percent of sexually active women in the general population and select population groups who have had a Pap test in the past 3 years
8. Percent of adults 50 years and older in general and select population groups who have had a flexible sigmoidoscopic exam in the past 5 years
9. Percent of general population and select population groups at elevated risk for diabetes who have had blood glucose screening in past year

Indicator Category: Access to Quality Health Care

Suggested Measures

1. Percent of general population and select population groups without health care coverage
2. Percent of infants in the general population and select population groups receiving all recommended immunizations by 19 to 35 months
3. Percent of adults 18 years and older in the general population and select population groups having had age-appropriate immunization coverage
4. Percent of general population and select population groups with health insurance coverage for substance abuse treatment programs
5. Percent of general population and select population groups currently identified as substance abusers who have been referred to treatment 6 Percent of general population and select population groups with health insurance coverage for clinical preventive services
6. Percent of general population and select population groups living within 100 miles of a tertiary care center

Indicator Category: Community Prevention

Suggested Measures

1. Percent of eligible students in general population and select population groups who have completed high school
2. Age-specific and age-adjusted morbidity, and mortality rates attributable to firearms for the general population and select population groups

3. Percent of general population and select population groups who have experienced personal crime or physical violence
4. Age-adjusted and age-specific morbidity and mortality rates attributable to motor vehicle accidents among the general population and select population groups
5. Percent of the general population and select population groups who are homeless (including those living in shelters for the homeless)