The committee is grateful for the opportunity to provide input about the criteria for selecting Leading Health Indicators (LHIs), and looks forward to offering additional input in our second report in the form of recommendations for core objectives and the LHIs themselves. The committee has noted that the Secretary’s Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2030 (SAC) and the Department of Health and Human Services are developing communication plans with attention to a wide range of stakeholders and implementing partners for Healthy People 2030 (SAC, 2018c). The committee commends the broad-based approach reflected in the work of the SAC, including the development of supplemental briefs that shed light on the SAC’s thinking about the foundational principles in the Healthy People 2030 (HP2030) Framework. The committee affirms the importance of having LHIs that address that broad approach.
The LHI criteria include that when viewed as a group, LHIs are “balanced between common, upstream root causes of health and well-being and measures of high-priority health states” and are “understandable and will resonate with diverse stakeholders to drive action.” The latter criterion calls for dissemination and communication, the importance of which is underscored by the fact many people may equate health with medical care and may be unfamiliar with the contributions to health and well-being of nonclinical factors such as education and social cohesion (Ortiz and Johannes, 2018; Robert and Booske, 2011). Although the understanding among the experts of what creates health and well-being is changing rapidly, approximately one-third of Americans recognize that
their surroundings influence their health (Carman et al., 2019). Healthy People 2030 offers an exceptional opportunity toward creating a shared understanding of what is needed, beyond medical care and its complexity, to build the conditions for health and well-being, and thus, toward influencing a balanced portfolio of investments in what can make the nation and its communities healthier, more vibrant, and more prosperous. Those approaches and investments are needed to address both behaviors and individual decision making, as well as sociodemographics—the “upstream” and ecological factors that shape individual decisions and trajectories (Lantz et al., 2010).
Many Americans are uninformed about inequity and its structural and historic causes (Pew, 2019). The LHIs offer an opportunity to highlight the state of upstream social structural factors that drive social disparities in health and well-being, and show that racial health inequities impose a broader cost on society (LaVeist et al., 2011). U.S. communities and states are also facing several macroeconomic and environmental threats that may present serious challenges to the work of promoting health and well-being. The LHIs provide an important opportunity to put in place some key tracking mechanisms that highlight the relationships among health and well-being and such factors as wealth inequality, mass incarceration, and unaffordable housing.