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1 Introduction At the request of the Department of Health and Human Services (HHS) Office of the Assistant Secretary for Health, the National Academies of Sciences, Engineering, and Medicine appointed a committee of experts to assist HHS with one component of the Healthy People initiative. Healthy People is a decadal HHS effort launched in 1979 to âdevelop a framework for improving the health of all people in the United Statesâ and offer âa strategic agenda to align health promotion and disease prevention activities in communities around the countryâ (Azar, 2018). The National Academies committee was given the following statement of task: The Department of Health and Human Services, Office of the Assistant Secretary for Health, requests that the National Academies of Sciences, Engineering, and Medicine convene an ad hoc committee to assist in the development of Leading Health Indicators (LHIs) for Healthy People 2030. The committee will develop (1) recommendations regarding the criteria for selecting LHIs and (2) a slate of LHIs that will serve as options for the Healthy People Federal Interagency Workgroup to consider as they develop the final criteria and set of LHIs for Healthy People 2030. The committee may identify gaps and may recommend new objectives for LHI consideration that meet the core objective criteria. This brief report represents the National Academies committee (or âthe committeeâ) response to the first portion of the charge, providing a review of the criteria for selecting LHIs along withâin response to the last sentence of the chargeâcomments about the Healthy People 2030 objectives (HP2030 objectives), currently extant in draft form. This report lays the groundwork for the second report, which will provide additional comments about the HP2030 objectives from which LHIs are to be selected, and will recommend a slate of LHIs. At the time the National Academies committee began its work in late 2018, the Secretaryâs Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2030 (SAC) had met 12 times and had developed the framework for Healthy People 2030 (HP2030 Framework) incorporating a round of public comments. The SAC has prepared seven reports, on topics including the criteria for selecting the HP2030 objectives and the criteria for selecting the LHIs, and the SAC also worked with outside experts to prepare a series of briefs intended to âclarify, discuss, and offer insightsâ about the HP2030 framework (see Box 1-1 for the framework) (SAC, 2019a). By late 2018, the Federal Interagency Workgroup (FIW), which includes HHS agencies and representatives of other federal departments, had also met to generate the HP2030 objectives, which were expected to be aligned with the HP2030 framework. The draft objectives were released for public comment between December 2018 and January 2019. 1-1 PREPUBLICATION COPY: UNCORRECTED PROOFS
1-2 LEADING HEALTH INDICATORS BOX 1-1 Healthy People 2030 Framework: Vision, Mission, Principles, Goalsa (developed by the Secretaryâs Advisory Committee) Vision: A society in which all people can achieve their full potential for health and well-being across the life span. Mission: To promote, strengthen, and evaluate the nationâs efforts to improve the health and well-being of all people. Foundational principles: Foundational principles explain the thinking that guides decisions about Healthy People 2030. The health and well-being of all people and communities are essential to a thriving, equitable society. Promoting health and well-being and preventing disease are linked efforts that encompass physical, mental, and social health dimensions. Investing to achieve the full potential for health and well-being for all provides valuable benefits to society. Achieving health and well-being requires eliminating health disparities, achieving health equity, and attaining health literacy. Healthy physical, social, and economic environments strengthen the potential to achieve health and well-being. Promoting and achieving the nationâs health and well-being is a shared responsibility that is distributed across the national, state, tribal, and community levels, including the public, private, and not- for-profit sectors. Working to attain the full potential for health and well-being of the population is a component of decision-making and policy formulation across all sectors. Overarching goals: Attain healthy, thriving lives and well-being, free of preventable disease, disability, injury and premature death. Eliminate health disparities, achieve health equity, and attain health literacy to improve the health and well-being of all. Create social, physical, and economic environments that promote attaining full potential for health and well-being for all. Promote healthy development, healthy behaviors, and well-being across all life stages. Engage leadership, key constituents, and the public across multiple sectors to take action and design policies that improve the health and well-being of all. Plan of action: Set national goals and measurable objectives to guide evidence-based policies, programs, and other actions to improve health and well-being. Provide data that is accurate, timely, accessible, and can drive targeted actions to address regions and populations with poor health or at high risk for poor health in the future. Foster improvement through public and private efforts to improve health and well-being for people of all ages and the communities in which they live. Provide tools for the public, programs, policy makers, and others to evaluate progress toward improving health and well-being. Share and support the implementation of evidence-based programs and policies that are replicable, scalable, and sustainable. Report biennially on progress throughout the decade from 2020 to 2030. Stimulate research and innovation toward meeting Healthy People 2030 goals and highlight critical research, data, and evaluation needs. Facilitate development and availability of affordable means of health promotion, disease prevention, and treatment. NOTE: The Healthy People framework includes a preamble that summarizes the background, history, and contributions of the Healthy People initiative. a https://www.healthypeople.gov/2020/About-Healthy-People/Development-Healthy-People- 2030/Framework (accessed July 9, 2019) PREPUBLICATION COPY: UNCORRECTED PROOFS
INTRODUCTION 1-3 SOURCE: HHS, 2019a. Because the HP2030 objectives will not be finalized and released until 2020, the National Academies committee was asked to first comment on the draft LHI criteria and then, in preparation for the its second report proposing a set of LHIs to inform the work of the FIW, review the objectives and identify relevant gaps in the core objectives in accordance with the core objective criteria. Figure 1-1 describes the main inputs and timeline for the LHIs for Healthy People 2030. FIGURE 1-1 Main inputs into and timeline for the selection of Leading Health Indicators by HHS and the FIW. NOTE: HP2030 = Healthy People 2030; LHI = Leading Health Indicators; SAC = Secretaryâs Advisory Committee PREPUBLICATION COPY: UNCORRECTED PROOFS
1-4 LEADING HEALTH INDICATORS REFLECTIONS ON THE HP2030 FRAMEWORK The SACâs Recommendations for the Healthy People 2030 Leading Health Indicators (2018a) described the HP2030 Framework as âa foundation for the criteria for selecting LHIs for the Healthy People 2030 initiative.â In the same report, the SAC stated that it was proposing âcriteria for selecting Healthy People 2030 LHIs that are informed by the Healthy People 2030 Framework,1 including the vision, mission, foundational principles, overarching goals, and plan of action.â The National Academies committee recognizes that the HP2030 framework has built considerably on the foundation of previous Healthy People efforts by broadening the conceptual framing of the initiative to strengthen the emphasis on health equity; expand the consideration of the social, environmental, and economic determinants of health; and add the useful and multidimensional notion of well-being. This evolution of the HP2030 Framework is consistent with recent advances in the understanding of those factors that lead to better health and well- being, and the set of issue briefs released by the SAC provides context and the evidence base for the main elements of the framework (SAC, 2019a). Below, the National Academies committee further discusses the relevance of the major elements of the HP2030 framework to the HP2030 objectives and LHIs: â¢ The health equity focus of the framework underscores the importance of disaggregating information, when feasible, about the LHIs by race, ethnicity, rurality, and other characteristics. However, this is not enough. Measures of health equity are also needed. In defining health equity as âthe principle underlying a commitment to reduceâand, ultimately, eliminateâdisparities in health and in its determinants, including social determinants,â Braveman (2014) referred to Healthy People 2020 as the first time that a federal government entity defined health disparity with specificity. Healthy People 2020 described disparities as âlinked with economic, social, or environmental disadvantageâ or with other âcharacteristics historically linked to discrimination or exclusionâ (HHS, 2010). Braveman added to the definition that âpursuing health equity means striving for the highest possible standard of health for all people and giving special attention to the needs of those at greatest risk of poor health, based on social conditionsâ (Braveman, 2014). â¢ The determinants of health focus calls for both acknowledging the evidence showing those factors account for the largest effect on health outcomes, and highlighting the value of a cross-sector and all-levels-of-government approach to health promotion. â¢ The well-being focus is consonant with the longstanding World Health Organization definition of health and its physical, mental, and social dimensions, (WHO, 2014) and it offers a further link for engaging the attention of sectors that make important contributions to population well-being, for exploring the metrics available from those other sectors, and for comparing against what other countries measure. A key aspect of this focus is that health is not simply the absence of disease or injury; it is also related to being well in social and emotional terms. 1 Underline added for emphasis. PREPUBLICATION COPY: UNCORRECTED PROOFS