Issues and Challenges
Review of the sample indicator sets demonstrates the need for additional data collection and analysis to be conducted before the committee determines sets of indicators to recommend to the Secretary of Health and Human Services. Some obvious modifications that will be made include the following: (1) identification and evaluation of additional indicator sets; (2) reduction of the number of suggested measures for each set of indicators; (3) revision and clarification of the wording for specific suggested measures for each indicator category; (4) prioritization of the indicator set(s) that could be used to assess public opinion and reactions through focus group discussions; and (5) identification of appropriate data sources for each measure that is selected or recommendation of a new data collection effort to provide the desired information. The committee is also working to resolve a number of additional issues concerning the format, content, measurement, and dissemination of different indicators and their associated measures. These are summarized briefly below.
- How can a balance be achieved between indicator sets that affect change at the individual level and those that have a primary focus on the community?
- How can a balance be achieved that will ensure representation of both determinants and outcomes of health?
- How can indicators and measures be selected that are based on good science rather than public opinion?
- How can health measures, social determinants, and community measures be balanced in one set of indicators; is it more feasible to have three small sets of leading health indicators representative of each of these areas?
- How can focus be retained the way the public views health without losing sight of the science?
- How to maintain the importance of having indicators and related measures “shaped” by public comment?
- How can credibility and support for indicators and measures be maintained with individuals, groups, organizations, health professionals and others involved in the delivery of health care education and services to the general public and select population groups?
- Are there more effective ways to deal with the health disparities issue?
- How do we deal with “end-of-life-issues” such as pain relief, nursing home care, and extreme measures to extend life?
- How do we deal with the growing field of genetics with respect to genetic susceptibility to disease, gene therapy, and the ability to manipulate genes and alter health status and outcomes?
- How do we deal with computer technology, data collection, data reporting, and the confidentiality of medical records and research?
- How do we deal with the issue that the leading health indicators imply some sort of normative standard for the achievement or performance (as do all the objectives for Healthy People 2010) that may or may not be acceptable to the general public or select population groups?