conduct of a public hearing during July 1998 and January 1999, respectively, to elicit further comments on leading health indicator sets, and


    final selection of conceptual frameworks and candidate indicator sets.

    A brief description of each of these activities is provided in the following narrative.

    Charge to Committee

    The committee received its charge from the U.S. Department of Health and Human Services and had several opportunities for periodic review and clarification. The initial charge emphasized that candidate leading health indicator sets should (1) elicit interest and awareness among the general population and diverse population groups, (2) motivate these diverse population groups to undertake activities to improve the status of specific indicators and thereby improving the overall health of the nation, (3) provide ongoing feedback to these populations and the members of the public and private health care communities concerning progress toward achieving sustained improvements in the indicators. In subsequent discussions with staff from the U.S. Department of Health and Human Services, the committee came to understand that the charge also included the development of suggestions for communications and dissemination strategies to promote awareness of the leading health indicators and galvanize actions to improve the status of those indicators. It was also established that clear linkages should be demonstrated between the proposed indicator sets and the full draft of Healthy People 2010, including the two overarching goals, four enabling goals and 26 focus areas. Finally, additional clarification about the committee charge included the recommendation that the candidate indicator sets should contain no more than 10 indicators and that any proposed indicator set should be supported by a conceptual framework around which the specific indicators could be organized.

    Review of Relevant Literature

    The committee reviewed and discussed a wide array of previous work related to the concept of leading health indicators and suggested candidate indicators for inclusion in a set of such indicators. Prominent among these was work from the two previous decades of Healthy People and the March 1998 report from the Working Group on Sentinel Health Objectives (U.S. Public Health Service, 1979; U.S. Department of Health and Human Services, 1980, 1986, 1998a; National Center for Health Statistics, 1992, 1994, 1995, 1996, 1997) Included in the Working Group report were five organizing frameworks for leading health indicators, suggestions of specific indicators, and a proposal for nine criteria to be used to guide the committee's final selection of indicators. In addition, the committee gave careful consideration to the Healthy Communities 2000 project in which communities across the nation developed indicators to monitor the health of their populations and provided feedback concerning progress toward achieving indicator objectives (American Public Health Association, 1991). Another source used by the committee was the work of the Coalition for Healthier Cities, and Communities, and particularly the publication of Community Indicators: An Inventory (1997). The committee also familiarized itself with the literature on community health report cards.

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