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Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

State of the USA Health Indicators L e t t e r R e p o r t Committee on the State of the USA Health Indicators Board on Population Health and Public Health Practice

THE NATIONAL ACADEMIES PRESS  500 Fifth Street, N.W.  Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Gov- erning Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engi- neering, 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. This study was supported by contracts between the National Academy of Sci- ences and the State of the USA, Inc. (4108); F.B. Heron Foundation (Unnumbered Award); and William and Flora Hewlett Foundation (2007-9452). Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project. International Standard Book Number-13:  978-0-309-12862-9 International Standard Book Number-10:  0-309-12862-5 Additional copies of this report are available from the National Academies Press, 500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2009 by the National Academy of Sciences. 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 serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin. Suggested citation: IOM (Institute of Medicine). 2009. State of the USA Health Indi- cators: Letter Report. Washington, DC: The National Academies Press.

“Knowing is not enough; we must apply. Willing is not enough; we must do.” —Goethe Advising the Nation. Improving Health.

The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal govern- ment on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its mem- bers, sharing with the National Academy of Sciences the responsibility for advis- ing the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in pro- viding services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

COMMITTEE ON THE STATE OF THE USA HEALTH INDICATORS GEORGE J. ISHAM (Chair), Medical Director and Chief Health Officer, HealthPartners RON BIALEK, President, Public Health Foundation NORMAN M. BRADBURN, Tiffany and Margaret Blake Distinguished Service Professor Emeritus, University of Chicago, and Senior Fellow, National Opinion Research Center CAROLINE FICHTENBERG, Chief Epidemiologist, Baltimore City Health Department JESSIE GRUMAN, Executive Director, Center for the Advancement of Health DAVID HOLTGRAVE, Professor and Chair, Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health CARA V. JAMES, Senior Policy Analyst, Henry J. Kaiser Family Foundation DAVID A. KINDIG, Professor Emeritus of Population Health Sciences, Emeritus Vice Chancellor for Health Sciences, University of Wisconsin–Madison School of Medicine LISA A. LANG, Assistant Director, Health Services Research Information, and Head, National Information Center on Health Services Research and Health Care Technology, National Library of Medicine DAVID R. NERENZ, Director, Center for Health Services Research, and Director, Outcomes Research, Neuroscience Institute, Henry Ford Health System JAMES D. RESCHOVSKY, Senior Health Researcher, Center for Studying Health System Change STEVEN TEUTSCH, Executive Director, U.S. Outcomes Research, Merck & Co., Inc. DAVID R. WILLIAMS, Florence and Laura Norman Professor of Public Health, Professor of African and African American Studies and of Sociology, Department of Society, Human Development, and Health, Harvard School of Public Health ALAN ZASLAVSKY, Professor of Health Care Policy (Statistics), Harvard Medical School Study Staff LYLA M. HERNANDEZ, Study Director ERIN HAMMERS, Research Associate ERIN RUSCH, Senior Program Assistant CHRISTIE BELL, Financial Officer ROSE MARIE MARTINEZ, Director, Board on Population Health and Public Health Practice 

Reviewers 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 National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its pub- lished 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 review of this report: Joyce Dubow, AARP Office of Policy and Strategy Sandro Galea, Center for Social Epidemiology and Population Health, University of Michigan Theodore G. Ganiats, Department of Family and Preventive Medicine, University of California–San Diego Norma Kanarek, Department of Environmental Health Science, Johns Hopkins Bloomberg School of Public Health and Oncology Center, Johns Hopkins University School of Medicine Eric B. Larson, Group Health, Center for Health Studies Randolph A. Miller, Vanderbilt University Medical Center Margaret E. O’Kane, National Committee for Quality Assurance Thomas Ricketts III, Cecil G. Sheps Center for Health Services Research and Department of Health Policy and Management, The University of North Carolina–Chapel Hill vii

viii REVIEWERS Although the reviewers listed above have provided many construc- tive comments and suggestions, they were not asked to endorse the con- clusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by Kristine M. Gebbie, School of Nursing, Hunter College, The City University of New York, and Nancy E. Adler, Departments of Psychiatry and Pediatrics and Center for Health and Community, University of California–San Francisco. Appointed by the National Research Council and Institute of Medicine, they were responsible for making certain that an independent examination of this report was carried out in accordance with institu- tional procedures and that all review comments were carefully consid- ered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

Acknowledgments Over the course of this study, many individuals were willing to share their expertise, time, and thoughts with the committee. Their contribu- tions invigorated committee deliberations and enhanced the quality of this report. The study sponsor, the State of the USA, Inc. (SUSA) willingly pro- vided information and responded to questions. The committee is particu- larly grateful to Joel Gurin and Jerilyn Asher of SUSA and Nicole Lurie of the RAND Corporation for their input. Invaluable background information on existing indicator sets was provided by Cheryl Wold in her report, Health Indicators: A Review of Reports Currently in Use. The committee greatly appreciates the input of speakers whose presentations informed committee thinking including Carter Blakey, Robert Groves, Joel Gurin, Christopher Hoenig, Richard J. Klein, Nicole Lurie, and Cheryl Wold. The committee was extremely fortunate in its staffing for this study. We wish to thank Lyla M. Hernandez, who did a remarkable job of direct- ing the study. Thanks also go to Erin Hammers for her excellent research support and to Erin Rusch for her flawless administrative support. ix

Contents COMMITTEE CHARGE 2 COMMITTEE PROCESS 3 TRACKING PROGRESS IN HEALTH AND HEALTH CARE 3 FRAMEWORK FOR INDICATOR DEVELOPMENT 5 INDICATORS 8 Health Outcomes, 8 Health-Related Behaviors, 20 Health Systems, 32 The Social and Physical Environment, 47 DISPARITIES 49 Disparity Groups, 50 Indicators to Be Included in Disparities Reporting, 52 Conceptual and Measurement Issues for Disparities Reporting, 53 How Disparities Might Be Featured on the Website, 55 RECOMMENDATIONS 56 REFERENCES 59 xi

xii CONTENTS APPENDIXES A Agenda 69 B Some Current Health Indicator Reports 71 C Domain Estimates, Reliability, and Small-Area Estimation 73 D The Commonwealth Fund Algorithm and Coding for Preventive Services 79

Tables, Figures, and Boxes TABLES 1 Life Expectancy at Birth by Race and Sex for Selected Years, 10 2 Life Expectancy at Birth for Selected Countries and Selected Years, 11 3 Healthy Eating Index: 2005 Components and Standards for Scoring, 26 4 Early 20th-Century Morbidity from Eight Diseases Compared with Morbidity from 1998, 44 FIGURES 1 Framework for health and health care indicator development, 5 2 Body mass index based on height and weight, 27 3 Income disparities in exercise rates, 51 BOXES 1 Costs of Chronic Disease, 17 2 Overweight and Obesity: Health Consequences, 29 3 Persons at High Risk for Complications from Influenza or In Close Contact with High-Risk Individuals, 42 xiii

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Researchers, policymakers, sociologists and doctors have long asked how to best measure the health of a nation, yet the challenge persists. The nonprofit State of the USA, Inc. (SUSA) is taking on this challenge, demonstrating how to measure the health of the United States. The organization is developing a new website intended to provide reliable and objective facts about the U.S. in a number of key areas, including health, and to provide an interactive tool with which individuals can track the progress made in each of these areas.

In 2008, SUSA asked the Institute of Medicine's Committee on the State of the USA Health Indicators to provide guidance on 20 key indicators to be used on the organization's website that would be valuable in assessing health. Each indicator was required to demonstrate:

  • a clear importance to health or health care,
  • the availability of reliable, high quality data to measure change in the indicators over time,
  • the potential to be measured with federally collected data, and
  • the capability to be broken down by geography, populations subgroups including race and ethnicity, and socioeconomic status.

Taken together, the selected indicators reflect the overall health of the nation and the efficiency and efficacy of U.S. health systems. The complete list of 20 can be found in the report brief and book.

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