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--> Leading Health Indicators for Healthy People 2010 Second Interim Report Committee on Leading Health Indicators for Healthy People 2010 Division of Health Promotion and Disease Prevention INSTITUTE OF MEDICINE NATIONAL ACADEMY PRESS Washington, D.C. 1999
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--> NATIONAL ACADEMY PRESS 2101 Constitution Avenue, N.W. Washington, DC 20418 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under the Academy's 1863 congressional charter of responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine. Support for this study was provided by the U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion (contract no. 282-98-0018). The views presented are those of the Institute of Medicine Committee on Leading Health Indicators for Healthy People 2010 and are not necessarily those of the funding organization. International Standard Book No. ISBN 0-309-06383-3 Additional copies of this report are available for sale from: National Academy Press 2101 Constitution Avenue, N.W., Box 285 Washington, DC 20055 Call (800) 624-6242 or (202) 334-1318 (in the Washington metropolitan area) or visit the NAP's on-line bookstore at http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at http://www2.nas.edu/iom. Copyright 1998 by the Institute of Medicine. All rights reserved. Printed in the United States of America The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The image adopted as a logo type by the Institute of Medicine is based on a relief carving from ancient Greece, now held by the Staatliche Musseen in Berlin.
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--> Committee on Leading Health Indicators for Healthy People 2010 Roger J. Bulger, MD, (Chair),* Executive Director, Association of Academic Health Centers, Washington, DC Susan M. Allan, MD, JD, MPH, Health Director, Public Health Division, Arlington, Virginia Neal Halfon, MD, MPH, Professor, School of Public Health, School of Public Health, University of California, Los Angeles Barbara S. Hulka, MD, MPH,* Kenan Professor, Department of Epidemiology, University of North Carolina, Chapel Hill Thomas J. Kean, MPH, President, Strategic Health Concepts, Inc., Englewood, CO Scott C. Ratzan, MD, MPH, Executive Director, Health Communication Technology and Educational Innovation, Academy for Educational Development, Washington, DC Stephen C. Schoenbaum, MD, MPH, President and Regional Medical Director, Harvard Pilgrim Health Care of New England, Providence, RI Mark A. Smith, MD, MBA, President and CEO, California HealthCare Foundation, Oakland Shoshanna Sofaer, DrPH, Schering Plough Professor of Health Policy, Baruch College, New York, NY Robert B. Wallace, MD, Professor of Preventive and Internal Medicine and Director, Cancer Center, Department of Preventive Medicine, University of Iowa, Des Moines Staff Carole A. Chrvala, Study Director Kelly Norsingle, Project Assistant Kathleen R. Stratton, Director, Division of Health Promotion and Disease Prevention Donna D. Duncan, Division Assistant * Member, Institute of Medicine
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--> Acknowledgments Healthy People has been a product of the efforts of many agencies and individuals during the course of the past two decades. The committee wishes to express its appreciation to those individuals involved in the evolution of Healthy People during this interval. This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the NRC's Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making the published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their participation in the review of this report: Erwin Bettinghouse, AMC Cancer Research Center; Ross Brownson, St. Louis University; Paul Frame, Tri-County Family Medicine; Gary Gunderson, Interfaith Health Program; LaDene Larsen, Utah Public Health Association; and Hugh Tilson, Glaxo Wellcome Company. While the individuals listed above have provided constructive comments and suggestions, it must be emphasized that responsibility for the final content of this report rests entirely with the authoring committee and the institution.
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--> Contents Executive Summary 1 1 Charge to the Committee 5 2 Criteria for Leading Health Indicators 7 3 Review of Relevant Data Issues 11 Data Sources, 11 Physiological Measures, 12 Timeliness of Data and Indicator Availability, 12 Small Area Analysis, 13 Representativeness, And Data Accuracy, 13 Ecological Measures: Social and Environmental, 14 Summary, 14 4 Core List of Candidate Leading Health Indicators 15 5 Sample Indicator Sets 19 Indicator Set A: Health Behavior and Access to Services, 19 Indicator Set B: Physical Health, Mental Health, Disability, Social Factors and Ecological Factors, 21 Indicator Set C: Ecological Factors, 26 Indicator Set D: Primary, Secondary, Tertiary Prevention, 28 Indicator Set E: Personal Behavior, Occupational Issues, Indicators or Disease, Services, Environment (POISE). 33 Indicator Set F: Enabling Goals For Healthy People 2010, 37
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--> 6 Issues and Challenges 43 7 Future Activities of IOM Committee 45 Refinement of Six Sample Indicator Sets, 45 Search for Additional Sample Indicator Sets, 46 Public Workshop, 46 Electronic Commentary, 46 Focus Group Discussions with Target Audiences, 46 8 Bibliography 49 Appendixes 50 Sample Set A Indicators, 51 Sample Set B Indicators, 55 Sample Set C Indicators, 59 Sample Set D Indicators, 63 Sample Set E Indicators, 67 Sample Set F Indicators, 71